An outbreak of Klebsiella pneumoniae and Enterobacter aerogenes bacteremia after interventional pain management procedures, New York City, 2008.
OBJECTIVE
In October 2008, an investigation was conducted into a cluster of gram-negative bloodstream infections after invasive pain management procedures at an outpatient facility to identify additional cases and determine the source of illness.


METHODS
We conducted a retrospective cohort study to determine exposures associated with illness. Eligible patients had an invasive procedure in the 4 days before or after the procedure date of the initial case-patients. Infection control assessments were made, and environmental specimens collected.


RESULTS
Four laboratory-confirmed case-patients (3 with Klebsiella pneumoniae and 1 with Enterobacter aerogenes) and 5 suspect case-patients were identified. In addition to the 9 confirmed and suspect case-patients, 45 patients were interviewed. All confirmed and suspect case-patients had a sacroiliac joint steroid injection procedure; injection into the sacroiliac joint was associated with illness (9/22 versus 0/31; P < 0.0001). Multiple breaches in infection control were noted including the reuse of single-use vials for multiple patients. The 3 K. pneumoniae with positive blood cultures were indistinguishable by pulse-field gel electrophoresis, and the E. aerogenes-positive blood culture was indistinguishable by pulse-field gel electrophoresis to the culture from an open vial of 100-mL iodixanol contrast solution.


CONCLUSIONS
Infection was associated with pain management procedures, specifically those involving injection to the sacroiliac joint. Lapses in infection control likely led to the contamination of single-use vials that were then used for multiple patients. Reuse of medication vials should be restricted, and affordable single-dose vials should be made available.
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, NY, USA.
Melissa R
MR
Wong
Paula
P
Del Rosso
Lisa
L
Heine
Veronica
V
Volpe
Lillian
L
Lee
John
J
Kornblum
Ying
Y
Lin
Marcelle
M
Layton
Don
D
Weiss
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects* / Q000379:methods; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004209:Disposable Equipment / Q000382:microbiology; D021902:Enterobacter aerogenes / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D004866:Equipment Contamination; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D017053:Infection Control; D007270:Injections, Intra-Articular; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D018710:Pain Clinics; D017410:Practice Guidelines as Topic; D011634:Public Health; D012189:Retrospective Studies; D012446:Sacroiliac Joint; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors
D013256:Steroids