Outbreak of Serratia marcescens bloodstream infections in patients receiving parenteral nutrition prepared by a compounding pharmacy.

Autor:	Gupta N; Epidemic Intelligence Service Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Hocevar SN; Epidemic Intelligence Service Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Moulton-Meissner HA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Stevens KM; Alabama Department of Public Health, Montgomery., McIntyre MG; Alabama Department of Public Health, Montgomery., Jensen B; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Kuhar DT; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Noble-Wang JA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Schnatz RG; Healthcare Quality Standards, United States Pharmacopeia, Rockville, Maryland., Becker SC; Healthcare Quality Standards, United States Pharmacopeia, Rockville, Maryland., Kastango ES; Clinical IQ, LLC, Madison, New Jersey., Shehab N; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia., Kallen AJ; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2014 Jul 01; Vol. 59 (1), pp. 1-8. Date of Electronic Publication: 2014 Apr 11.
DOI:	10.1093/cid/ciu218
Abstrakt:	Background: Compounding pharmacies often prepare parenteral nutrition (PN) and must adhere to rigorous standards to avoid contamination of the sterile preparation. In March 2011, Serratia marcescens bloodstream infections (BSIs) were identified in 5 patients receiving PN from a single compounding pharmacy. An investigation was conducted to identify potential sources of contamination and prevent further infections. Methods: Cases were defined as S. marcescens BSIs in patients receiving PN from the pharmacy between January and March 2011. We reviewed case patients' clinical records, evaluated pharmacy compounding practices, and obtained epidemiologically directed environmental cultures. Molecular relatedness of available Serratia isolates was determined by pulsed-field gel electrophoresis (PFGE). Results: Nineteen case patients were identified; 9 died. The attack rate for patients receiving PN in March was 35%. No case patients were younger than 18 years. In October 2010, the pharmacy began compounding and filter-sterilizing amino acid solution for adult PN using nonsterile amino acids due to a national manufacturer shortage. Review of this process identified breaches in mixing, filtration, and sterility testing practices. S. marcescens was identified from a pharmacy water faucet, mixing container, and opened amino acid powder. These isolates were indistinguishable from the outbreak strain by PFGE. Conclusions: Compounding of nonsterile amino acid components of PN was initiated due to a manufacturer shortage. Failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs. Improved adherence to sterile compounding standards, critical examination of standards for sterile compounding from nonsterile ingredients, and more rigorous oversight of compounding pharmacies is needed to prevent future outbreaks. (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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