title: Enterobacter cloacae bloodstream infections traced to contaminated human albumin.
abstract: In August 1996, a patient in Kansas developed an Enterobacter cloacae bloodstream infection (BSI) shortly after receiving Albuminar, a brand of human albumin. Albuminar contamination was suspected. A case-control study of patients with primary gram-negative bacterial BSIs showed that patients with E. cloacae BSIs were significantly more likely than patients with non-E. cloacae gram-negative BSIs to have received Albuminar within 3 days of developing their BSIs (3 of 5 vs. 0 of 9; OR, undefined; P=.03). The E. cloacae isolate from the Kansas patient was found by pulsed-field gel electrophoresis to be identical to the isolate from the patient's Albuminar vial, to isolates from 2 previously unopened Albuminar vials, and to an isolate from a Wisconsin patient who had received Albuminar. A worldwide recall of approximately 116,000 Albuminar vials took place. This multistate outbreak was detected because of clinical astuteness and prompt reporting. Combined epidemiological and laboratory approaches are valuable when investigating potentially contaminated blood components and plasma derivatives.
authors.affiliation: Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sjw8@cdc.gov
authors.forename: S A
authors.initials: SA
authors.lastname: Wang
authors.forename: J I
authors.initials: JI
authors.lastname: Tokars
authors.forename: P J
authors.initials: PJ
authors.lastname: Bianchine
authors.forename: L A
authors.initials: LA
authors.lastname: Carson
authors.forename: M J
authors.initials: MJ
authors.lastname: Arduino
authors.forename: A L
authors.initials: AL
authors.lastname: Smith
authors.forename: N C
authors.initials: NC
authors.lastname: Hansen
authors.forename: E A
authors.initials: EA
authors.lastname: Fitzgerald
authors.forename: J S
authors.initials: JS
authors.lastname: Epstein
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000382:microbiology / Q000635:transmission*; D016022:Case-Control Studies; D002675:Child, Preschool; D004340:Drug Contamination; D016972:Enterobacter cloacae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000382:microbiology / Q000635:transmission*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D012709:Serum Albumin