title: Sphingomonas paucimobilis bloodstream infections associated with contaminated intravenous fentanyl.
abstract: Nationally distributed medications from compounding pharmacies, which typically adhere to less stringent quality-control standards than pharmaceutical manufacturers, can lead to multistate outbreaks. We investigated a cluster of 6 patients in a Maryland hospital who had Sphingomonas paucimobilis bloodstream infections in November 2007. Of the 6 case-patients, 5 (83%) had received intravenous fentanyl within 48 hours before bacteremia developed. Cultures of unopened samples of fentanyl grew S. paucimobilis; the pulsed-field gel electrophoresis pattern was indistinguishable from that of the isolates of 5 case-patients. The contaminated fentanyl lot had been prepared at a compounding pharmacy and distributed to 4 states. Subsequently, in California, S. paucimobilis bacteremia was diagnosed for 2 patients who had received intravenous fentanyl from the same compounding pharmacy. These pharmacies should adopt more stringent quality-control measures, including prerelease product testing, when compounding and distributing large quantities of sterile preparations.
authors.affiliation: Division of Infectious Diseases, Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. lmaraga1@jhmi.edu
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Maragakis
authors.forename: Romanee
authors.initials: R
authors.lastname: Chaiwarith
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Francesca J
authors.initials: FJ
authors.lastname: Torriani
authors.forename: Edina
authors.initials: E
authors.lastname: Avdic
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Ross
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D003470:Culture Media; D004340:Drug Contamination; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D020578:Sphingomonas / Q000145:classification / Q000302:isolation & purification*
chemical_list: D000701:Analgesics, Opioid; D003470:Culture Media; D005283:Fentanyl