Abstract
Background
In June 2018, an unusual number of candidemia-associated sepsis cases were diagnosed in sedated patients hospitalized in the 12-bed adult ICU of a teaching hospital in Mexico. The pre-outbreak candidemia rate had been calculated at 0.66 cases/100 ICU admissions for the previous 3 years.
Methods
We performed a case–control and microbiological study designed to trace the source of the outbreak. Case definition included adult patients with systemic inflammatory response syndrome and Candida species isolated on BC (blood cultures). The rest of the patients in the ICU within the study period (6/12/2018–6/22/2018) were used as controls.
Results
A total of 5 cases and 19 controls were included in the study. Demographic and clinical characteristics were similar between groups, except for SOFA scores (Table 1). Differences in median SOFA scores between groups were statistically significant (7.5 in cases and 3 in controls (p = 0.02)). After review of common medications used between cases, propofol infusion use (5/5 in cases and 6/19 in controls) was calculated as the strongest risk factor for candidemia (OR 22.84 (p = 0.04)). In-use propofol infusions available at the time were stopped and sent for culture as were unopened vials stored in the pharmacy from the lot being used in the ICU. Intrinsical contamination with bacterial and fungal species related to the outbreak was identified (Table 3). Case fatality rate during the outbreak was 80% (4/5)
Conclusion
Lethal infections due to contaminated medications, including propofol, have been reported worldwide. Propofol is a potential source for infections given its lipophilic nature that promotes microbial growth. This likely remains an underecognized problem that deserves awareness for early recognition. Epidemiological surveillance in our hospital prompted our case–control study and the subsequent implementation of effective control measures including rapid notification to hospital and national authorities (COFEPRIS), elimination of the identified contaminated lot, and increased promotion of both hand hygiene and adequate IV medication handling techniques among staff.
Disclosures
All authors: No reported disclosures.
Secondary transmissions during the outbreak of Shiga toxin-producing Escherichia coli O104 in Hesse, Germany, 2011
