title: A cluster of fever and hypotension on a surgical intensive care unit related to the contamination of plasma expanders by cell wall products of Bacillus stearothermophilus.
abstract: OBJECTIVE
  To evaluate an outbreak of fever and hypotension after cardiac surgical procedures and the role of polygeline, a plasma expander.
  
  
  METHODS
  Unmatched case-control study.
  
  
  METHODS
  A six-bed cardiac surgery intensive care unit (SICU) of the Hospital Clinic of Barcelona (Spain), a 940-bed public teaching hospital.
  
  
  METHODS
  Eight cases and 25 control patients admitted to the SICU over a 4-week epidemic period.
  
  
  METHODS
  Development of hypotension (systolic blood pressure < or = 90 mm Hg or a drop of 40 mm Hg from baseline systolic blood pressure) and fever (axillary temperature > 38.5 degrees C) within 24 hours of a cardiac surgical procedure.
  
  
  RESULTS
  The single risk factor significantly different between cases and controls was the total volume of polygeline used throughout the surgical procedure for extracorporeal circulation: a median of 1,250 mL (mean, 1,312.5 +/- 842.5 mL) in cases versus 500 mL (mean, 566.0 +/- 159.9 mL) in controls (P = .0029). By multiple logistic regression analysis, polygeline use was the single risk factor significantly related to the outcome (odds ratio, 8.75; CI95, 1.36 to 56.2; P = .01). Neither blood cultures from patients nor cultures of the polygeline used yielded growth of any microorganism. Stopping use of the implicated polygeline lot controlled the outbreak.
  
  
  CONCLUSIONS
  Use of polygeline was associated with an outbreak of fever and hypotension in a SICU. Information from the manufacturer indicated the likelihood of contamination of the product with Bacillus stearothermophilus components. The manufacturer has since changed the production and control processes, and no further adverse events have been seen.
authors.affiliation: Infection Control Program, Hospital Clinic, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Trilla
authors.forename: C
authors.initials: C
authors.lastname: Codina
authors.forename: M
authors.initials: M
authors.lastname: Salles
authors.forename: J M
authors.initials: JM
authors.lastname: Gatell
authors.forename: M
authors.initials: M
authors.lastname: Zaragoza
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: J
authors.initials: J
authors.lastname: Mulet
authors.forename: J
authors.initials: J
authors.lastname: Ribas
authors.forename: M T
authors.initials: MT
authors.lastname: Jimenez de Anta
mesh_terms: D001426:Bacterial Proteins / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D016000:Cluster Analysis; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004340:Drug Contamination; D005334:Fever / Q000453:epidemiology* / Q000209:etiology; D001411:Geobacillus stearothermophilus / Q000648:ultrastructure*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000209:etiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011097:Polygeline / Q000009:adverse effects*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
chemical_list: D001426:Bacterial Proteins; D011097:Polygeline