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Published Date: 2007-12-20 09:00:21
Subject: PRO/EDR> Serratia marcescens, heparin syringe - USA: (IL,TX), alert
Archive Number: 20071220.4090

SERRATIA MARCESENS, HEPARIN SYRINGE - USA: (ILLINOIS, TEXAS), ALERT
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[1]
Date: Tue 18 Dec 2007
Source: Associated Press [edited]
<http://ap.google.com/article/ALeqM5j20sqsItq7UMZKLJ6MUW0PlTNOGAD8TK3SBO0>

Federal health officials said on Tuesday [18 Dec 2007] that they are
investigating dozens of blood infections in at least 2 states that have
been linked to medical syringes contaminated with bacteria. About 40 people
have been sickened in Illinois and Texas, including 20 outpatients from
Rush University Medical Center in Chicago [Illinois]. No deaths have been
reported.

Rush doctors traced the infections earlier in December 2007 to
heparin-filled syringes the patients used during home treatment for cancer
and other ailments. Heparin is a blood thinner [anticoagulant - Mod.LL],
and the syringes are used to keep clear catheters and intravenous lines.
The infections were caused by bacteria called _Serratia marcescens_, found
in a single batch of heparin-filled syringes made in Angier, NC, by a
company called Sierra Pre-Filled.

Syringes from that batch also were sent to Colorado, Florida and
Pennsylvania but infections so far have turned up only in Illinois and
Texas, said Dr Arjun Srinivasan of the federal Centers for Disease Control
and Prevention (CDC). The infections can cause fever and chills. They can
be serious but generally respond well to antibiotics.

There have been no known deaths, Srinivasan said. Of the 20 Rush
outpatients who fell ill, 14 required hospitalization. All responded
quickly to antibiotic treatment, and only one remained in hospital on
Tuesday [18 Dec 2007], said Dr. John Segreti, hospital epidemiologist.

The president of Sierra Pre-Filled, Dushyant Patel, said the company is
working with CDC and the Food and Drug Administration and has voluntarily
recalled the implicated lot. "There's nothing out there anymore," Patel
said. The affected lot is 070926H, Srinivasan said. He said that CDC is
working to make sure doctors are alerted about the contamination and that
more cases could surface.

He said bacteria were found in fluid from the pre-filled syringes, but it
is uncertain if the original contamination was in the heparin, the saline
used to dilute the drug, or the syringes themselves. "We'll be working to
perform genetic fingerprinting on the bacteria to confirm a link between
bacteria in the syringes and the case patients," Srinivasan said.

Patel said the heparin in his company's pre-filled syringes comes from a
different company.

[byline: Lindsey Tanner]

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communicated by:
ProMED-mail rapporteur Brent Barrett

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[2]
Date: Wed 19 Dec 2007
Source: Chicago (IL) Tribune [edited]
<http://www.chicagotribune.com/features/lifestyle/health/chi-rushinfection_19dec19,1,733956.story>

In an unusual outbreak of a dangerous infection, 21 Chicago-area patients
and as many as 20 more in Texas have contracted a bacterial disease from a
fluid they were receiving to prevent blood clots in intravenous lines,
hospital officials said on Tuesday [18 Dec 2007].

All but one of the Chicago-area patients who were treated for the infection
have been discharged from hospitals, and the last patient was to be
discharged late Tuesday [18 Dec 2007], said officials at Rush University
Medical Center, which was the 1st institution to detect the outbreak.

Epidemiologists at Rush discovered the problem on 5 Dec 2007 after an
unusual number of patients showed up with the infection, caused by a
bacteria called _Serratia marcescens_. All of the patients had intravenous
lines that they used for home infusions for a variety of reasons. The
hospital traced the infections to a batch of syringes filled with heparin,
an anti-clotting drug.

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communicated by:
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******
[3]
Date: Wed 19 Dec 2007
Source: Dallas (TX) Morning News [edited]
<http://www.dallasnews.com/sharedcontent/dws/news/localnews/stories/121907dnmetneedles.27f3693.html>

Federal officials are investigating how 20 patients of an oncology clinic
in the Dallas area were sickened by medical syringes contaminated with
bacteria. The Texas Department of State Health Services confirmed Tuesday
[18 Dec 2007] that the Dallas-area patients were among those exposed to a
batch of tainted syringes that was shipped to 5 states and also infected
people in Illinois. No deaths were reported.

The bacterium, called _Serratia marcescens_, can cause fever and chills but
generally responds to antibiotics. It contaminated syringes that contained
the drug heparin, a blood thinner used during home treatment of cancer and
other ailments. Some of the Dallas-area patients became so ill after the
bacterial exposure that they required hospitalization, said health
department spokesman Doug McBride. "We understand that all of them
recovered," he said. The exposure occurred between mid-November and the 1st
week of December 2007, he said. Mr McBride declined to identify the cancer
clinic involved in the incident.

[byline: Sherry Jacobson]

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ProMED-mail <promed@promedmail.org>

[_Serratia marcescens_ can cause a wide variety of hospital-acquired
infections and has been associated with infections in injecting drug users,
particularly endocarditis and osteomyelitis. Immunologically healthy
individuals can acquire _S. marcescens_ infection especially in the
hospital setting. The organism is widespread in the environment but not a
common component of the human fecal flora.

Environmental and even some clinical strains of _S. marcescens_ can produce
a red pigment called prodigiosin. Bartolemeo Bizio 1st described the
organism in 1819 as the cause of red discoloration of polenta (a dish made
from corn meal), which discredited the claim that the color was due to the
miraculous appearance of blood. He gave the organism its genus name to
honor Serafino Serrati, whom he felt had not received proper credit for
invention of the steamboat, and its species name for the Latin word for "to
decay" because of the tendency of the pigment to change color as the
colonies age. Serial passage may also cause the organism to lose its
pigment-producing ability.

The production of the pigment together with the belief that the bacterium
was nonpathogenic led to its use as a biologic marker to study, among other
things, transmission of bacteria through speech and contact, ascending
colonization of the bladder in patients with urinary catheters, and the
dissemination of aerosolized bacteria after experimental release in models
of biologic warfare. - Mod.LL]

See Also