Epidemiologic Notes and Reports Pseudomonas aeruginosa
Peritonitis Attributed to a Contaminated Iodophor Solution --
Georgia
Five infections involving patients at a hospital have been
attributed to use of contaminated Prepodyne Solution.* Intrinsic
contamination of this iodophor product with Pseudomonas aeruginosa
has
been confirmed by CDC, and investigation by the Food and Drug
Administration (FDA) and CDC is continuing.
In the period March 9-April 12, 1982, 5 chronic peritoneal
dialysis patients at a municipal hospital in Atlanta became
infected
with P. aeruginosa. Four patients developed peritonitis, and 1
developed a skin infection at the catheter insertion site. All 4
patients with peritonitis had low-grade fever, cloudy peritoneal
fluid, and abdominal pain. Three of these patients used an
automatic
peritoneal dialysis machine; 1 used only a bottle up machine.
All patients had permanent indwelling peritoneal catheters, which
were
wiped with a 4x4 gauze soaked with an iodophor, Prepodyne Solution,
each time the catheter was connected to or disconnected from
machine
tubing. Aliquots of Prepodyne Solution were transferred from stock
bottles to smaller in-use bottles.
Infection-control personnel at the hospital obtained cultures
of
the dialysate concentrate, internal areas of the dialysis machines,
and a small in-use plastic container that had been filled with
Prepodyne Solution. All cultures were negative except the
Prepodyne
Solution, which yielded a pure culture of P. aeruginosa.
Subsequently, 2 of 8 unopened 1-gallon containers of Prepodyne
Solution, lot C109756, one obtained from the dialysis center and a
second from another hospital area, were culture-positive; they,
too,
yielded a pure culture of P. aeruginosa. The antimicrobial
susceptibility patterns of the isolates obtained from the Prepodyne
Solution were identical to those of 2 available isolates from
patients; these organisms were sensitive when tested in the
hospital
to amikacin, carbenicillin, gentamicin, kanamycin, tetracycline,
tobramycin, and trimethoprim-sulfamethoxazole, and were resistant
to
ampicillin and cephalothin.
Reported by PL Parrott, RN, PM Terry, M(ASCP), B Whitworth, RN, L
Frawley, RN, JE McGowan Jr, MD, Grady Memorial Hospital, Atlanta,
RK
Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources;
Hepatitis and Viral Enteritis Div, Hospital Infections Program,
Center
for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Intrinsic contamination of Prepodyne Solution, lot
C109756, has been confirmed by CDC in 1 of 2 unopened 1-gallon
containers. The product is manufactured for AMSCO/Medical Products
Division by West Chemical Products, Inc. FDA and CDC are currently
investigating the source of this intrinsic contamination, the
extent
of contamination (in terms of products, lots, and distribution),
and
the factors permitting the survival of P. aeruginosa in this
product
and in the bottles that were used. AMSCO has instituted a
voluntary
withdrawal of lot C109756 (1-gallon containers), and has notified
hospitals that had received the implicated lot. Personnel in
hospitals using this product may wish to review patient infections
caused by P. aeruginosa and notify appropriate local or state
health
departments about any unusual problems.
This is the second report of contamination of an iodophor
solution
(1,2) and the first of a poloxamer-iodine solution.
Poloxamer-iodine
and povidone-iodine are the most commonly used iodophor
preparations
in hospitals; both preparations have now been demonstrated to be
vulnerable to intrinsic contamination. Pseudobacteremia has been
described in association with the use of a contaminated iodophor
preparation; the report above demonstrates that contaminated
solutions
may lead to true infections. Although several iodophor antiseptic
preparations, of which Prepodyne Solution is one, are widely used
in
hospitals for disinfectant purposes, they are FDA-approved only for
antisepsis of skin and mucous membranes.
References
Berkelman RL, Lewin S, Allen JR, et al. Pseudobacteremia
attributed to contamination of povidone-iodine with Pseduomonas
cepacia. Ann Intern Med 1981;95:32-6.
Craven DE, Moody B, Connolly MG, Kollisch NR, Stottmeier KD,
McCabe WR. Pseudobacteremia caused by povidone-iodine solution
contaminated with Pseudomonas cepacia. N Engl J Med
1981;305:621-3.
*Use of trade names is for identification only and does not imply
endorsement by the Public Health Service or the the U.S. Department
of
Health and Human Services.
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