title: Staphylococcus aureus bloodstream infections among patients undergoing electroconvulsive therapy traced to breaks in infection control and possible extrinsic contamination by propofol.
abstract: Infectious complications associated with electroconvulsive therapy (ECT) are extremely unusual. When five of nine patients undergoing ECT at one facility on June 20, 1996 developed Staphylococcus aureus bloodstream infection (BSI), an investigation was initiated. A retrospective cohort study, a procedure review, and observational and microbiologic studies were performed. A case was defined as any patient who had ECT at Facility A from June 1, 1995 through June 20, 1996 and developed S. aureus BSI <30 days after ECT. The post-ECT S. aureus BSI rate was significantly greater on the epidemic day than the pre-epidemic period, (i.e., June 1, 1995 through June 19, 1996) (5 of 9 vs 0 of 54 patients, P < 0.001). All patients during the study period received propofol before ECT. Case patients were more likely than noncase patients to have higher maximum temperature after ECT (median 103.9 degrees F vs 100.0 degrees F, P < 0.03) and a greater time from preparation of intravenous medications to infusion (median 2.1 vs 1.1 h, P = 0.01). All case-patient S. aureus isolates were indistinguishable by pulsed field gel electrophoresis. Our investigation suggests that the ECT-associated S. aureus BSIs were associated with infection control breaks, which possibly led to the extrinsic contamination of propofol. Prevention of propofol-associated infectious complications requires aseptic preparation and use immediately before infusion.
authors.affiliation: Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, United States Public Health Service, Department of Health and Human Services, Atlanta, Georgia 30333, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kuehnert
authors.forename: R M
authors.initials: RM
authors.lastname: Webb
authors.forename: E M
authors.initials: EM
authors.lastname: Jochimsen
authors.forename: G A
authors.initials: GA
authors.lastname: Hancock
authors.forename: M J
authors.initials: MJ
authors.lastname: Arduino
authors.forename: S
authors.initials: S
authors.lastname: Hand
authors.forename: M
authors.initials: M
authors.lastname: Currier
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D016470:Bacteremia / Q000382:microbiology* / Q000517:prevention & control; D015331:Cohort Studies; D004340:Drug Contamination; D004565:Electroconvulsive Therapy; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005334:Fever / Q000209:etiology; D006225:Hand / Q000382:microbiology; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D018024:Peer Review, Health Care; D015742:Propofol / Q000009:adverse effects*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000145:classification / Q000302:isolation & purification; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol