Outbreak of Serratia marcescens bloodstream and central nervous system infections after interventional pain management procedures

• Published in: The Clinical journal of pain Vol. 24; no. 5; p. 374
• Main Authors: Cohen, Adam L, Ridpath, Alison, Noble-Wang, Judith, Jensen, Bette, Peterson, Alicia M, Arduino, Matt, Jernigan, Dan, Srinivasan, Arjun
• Format: Journal Article
• Language: English
• Published: United States 01.06.2008
• Subjects: Adult; Aged; Aged, 80 and over; Case-Control Studies; Central Nervous System Bacterial Infections - chemically induced; Central Nervous System Bacterial Infections - diagnosis; Contrast Media - adverse effects; Disease Outbreaks - prevention & control; Female; Humans; Male; Middle Aged; Pain - diagnosis; Pain - drug therapy; Serratia Infections - chemically induced; Serratia Infections - diagnosis; Serratia marcescens - isolation & purification
• ISSN: 1536-5409
• DOI: 10.1097/AJP.0b013e31816157db

To determine the cause of an outbreak of Serratia marcescens infections in patients after interventional pain management procedures at an outpatient pain clinic. We conducted a case-control study and collected clinical and environmental samples. We identified 5 culture-confirmed case-patients and 2 presumptive case-patients who had no bacteria recovered from cultures. The 7 case-patients were compared with 28 controls who underwent procedures at the same clinic but did not develop symptoms of infection. All confirmed case-patients had S. marcescens bloodstream infections; 2 had concurrent S. marcescens central nervous system infections. Case-patients were more likely than controls to have procedures that used contrast solution or entered the epidural or intervertebral disc space (P< or =0.01 for each). All S. marcescens clinical isolates were indistinguishable by pulsed-field gel electrophoresis. We did not isolate S. marcescens from medications or environmental samples; however, S. marcescens was shown to survive and grow in contrast solution that was experimentally contaminated for up to 30 days. Single-dose vials of medication, including contrast solution, were used for multiple procedures; multiple medications were accessed with a common needle and syringe. The findings of this investigation suggest contamination of a common medication, likely contrast solution, as the source of the outbreak. Practices, such as reusing single-dose medication vials and using a common needle and syringe to access multiple medications, could have led to contamination and propagation of S. marcescens and should be avoided in interventional pain management procedures.