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Enterobacter cloacae bloodstream infections traced to contaminated
human albumin.
Clinical Infectious Diseases 2000;30(1):35-40.
Wang SA, Tokars JI, Bianchine PJ, Carson LA, Arduino MJ, Smith AL, Hanson
NC, Fitzgerald EA, Epstein JS, Jarvis WR.
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.