title: Contamination of intravenous fluids: a continuing cause of hospital bacteremia.
abstract: BACKGROUND
  Nosocomial bacteremia caused by the contamination of intravenous (IV) infusates is considered rare. Unfortunately, this problem has been underestimated because its identification requires culturing infusates, a procedure not performed routinely.
  
  
  METHODS
  This study was conducted in a referral hospital where IV infusates are admixed in nursing areas. The aim was to determine the prevalence of infusate contamination in adult patients with gram-negative rod (GNR) bacteremia. Over a period of 32 months, a specimen of infusate was drawn for culture from each patient recruited after the laboratory reported a GNR in the blood.
  
  
  RESULTS
  A total of 384 infusates were cultured from 384 patients who had been diagnosed with GNR bacteremia. Seven infusates grew a GNR in culture, for a contamination rate of 2% (7/384; 95% confidence interval [CI] = 1% to 3%). In all cases, the infectious organism was the same as the organism isolated from the blood. Infusate contamination was responsible for 7% (7/108; 95% CI = 2% to 11%) of all primary bloodstream infections and 11% (7/62; 95% CI = 2% to 22%) of all primary bloodstream infections not associated with central venous catheter infection.
  
  
  CONCLUSIONS
  For patients in hospitals where IV drugs are admixed in nursing units, we recommend instituting infusate culture as routine practice following the diagnosis of a GNR in the blood.
authors.affiliation: National Institute of Medical Sciences and Nutrition "Salvador Zubiran," Mexico City, Mexico; Department of Medicine, University of Guanajuato, Leon Guanajuato, Mexico. aaeemmhh@yahoo.com
authors.forename: Alejandro E
authors.initials: AE
authors.lastname: Macias
authors.forename: Martha
authors.initials: M
authors.lastname: Huertas
authors.forename: Samuel Ponce
authors.initials: SP
authors.lastname: de Leon
authors.forename: Juan M
authors.initials: JM
authors.lastname: Munoz
authors.forename: Alma R
authors.initials: AR
authors.lastname: Chavez
authors.forename: Jose
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.forename: Carmen
authors.initials: C
authors.lastname: Romero
authors.forename: Miriam
authors.initials: M
authors.lastname: Bobadilla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000209:etiology*; D003428:Cross Infection / Q000209:etiology*; D004340:Drug Contamination / Q000706:statistics & numerical data*; D005260:Female; D016946:Gram-Negative Aerobic Rods and Cocci / Q000302:isolation & purification*; D006761:Hospitals; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods*; D007275:Injections, Intravenous / Q000379:methods*; D008297:Male; D008875:Middle Aged