Table 2.
Outbreaks related to bacterial and fungal contamination of infusates in healthcare facilities in low- and middle-income countries: products involved, and pathogens isolated
| Author, year, country (n = 50) | Type and use of the infusate involved | Pathogens isolated (n = 56) |
|---|---|---|
|
Thong 1975 [2] Malaysia (lower-MIC) |
5% dextrose-saline used in pediatrics | Burkholderia cepacia |
|
Koopman 1980 [3] Colombia (lower-MIC) |
Saline-dextrose-potassium admixture used in pediatrics | Klebsiella pneumoniae |
|
Lacey 1991 [4] South Africa (lower-MIC) |
Intrinsically contaminated sterile distilled water used to reconstitute heparin for flushing central venous catheters in pediatrics | Ralstonia pickettii |
|
Frean 1994* [5] South Africa (lower-MIC) |
Intrinsically contaminated TPN used in pediatrics | Serratia odorifera |
|
Worku 1997* [6] Ethiopia (LIC) |
Saline-dextrose admixture used in pediatrics | Klebsiella oxytoca |
|
Kapil 1998* [7] India (Lower-MIC) |
mSDV of saline-heparin admixture used to flush intravascular catheters used in adults | Acinetobacter baumannii |
|
Mathews 1998 [8] India (lower-MIC) |
Case report of a neonate who received an IV fluid | Saprochaete capitata |
|
Thuler 1998* [9] Brazil (upper-MIC) |
Intrinsically contaminated IV calcium gluconate used in adults | Bacillus circulans |
|
Van Nierop 1998 [11] South Africa (upper-MIC) |
mSDV of IV amino acid premixture used in neonates | Enterobacter cloacae |
|
Lalitha 1999 [11] India (lower-MIC) |
Intrinsically contaminated dextrose used in neonates | Klebsiella pneumoniae |
|
Tresoldi 2000* [12] Brazil (upper-MIC) |
TPN used in neonates | Enterobacter cloacae |
|
Ganeswire 2003 [13] Malaysia (lower-MIC) |
mSDV of dextrose used to reconstitute antibiotics in neonates | Pluralibacter gergoviae |
|
Güngör 2003* [14] Türkiye (upper-MIC) |
mSDV of IV lipid premixture added to TPN solution, used in neonates | Elizabethkingia meningoseptica |
|
Habsah 2005* [15] Malaysia (lower-MIC) |
TPN used in neonates | Pantoea sp. |
|
Moodley 2005 [16] South Africa (upper-MIC) |
mSDV of dextrose-amino acid premixture used in neonates | Klebsiella pneumoniae |
|
Moore 2005 [17] Egypt (lower-MIC) |
mSDV of dextrose, MDV of a steroid and mSDV of an immunoglobulin solution used in neonates | Klebsiella pneumoniae |
|
Moreira 2005* [18] Brazil (upper-MIC) |
Intrinsically contaminated Water for Injection used in adults and neonates |
Burkholderia cepacia Ralstonia pickettii |
|
Marais 2006 [19] South Africa (upper-MIC) |
TPN used in neonates | Klebsiella pneumoniae |
|
Vegas 2006 [20] Venezuela (upper-MIC) |
TPN used in neonates | Acinetobacter sp. |
|
Campos 2007 [21] Brazil (upper-MIC) |
Intrinsically contaminated TPN used in neonates | Enterobacter hormaechei |
|
Dias 2008 [22] Brazil (upper-MIC) |
Intrinsically contaminated heparin used in adults and pediatrics | Pseudomonas putida |
|
Douce 2008 [23] Ecuador (lower-MIC) |
Intrinsically contaminated Water for Injection used to dilute antibiotics |
Burkholderia cepacia Myroides odoratus |
|
Narayan 2009 [24] Fiji (lower-MIC) |
mSDV of saline used to flush intravascular catheters and dilute antibiotics used in neonates | Klebsiella aerogenes |
|
Arslan 2010 [25] Türkiye (upper-MIC) |
TPN used in neonates | Serratia marcescens |
|
Martins 2010 [26] Brazil (upper-MIC) |
Intrinsically contaminated IV bromopride medication used in adults | Burkholderia cepacia |
|
Liu 2011 [27] China (lower-MIC) |
mSDV of heparinized saline used to flush intravascular catheters in adults | Serratia marcescens |
|
DeSmet 2013 [28] Cambodia (lower-MIC) |
mSDV of Ringer’s lactate used to flush intravascular catheters in adults | Burkholderia cepacia |
|
Liu 2014 [29] China (lower-MIC) |
Dextrose-saline-isosorbide dinitrate-potassium aspartate admixture used in adults | Pseudomonas fulva |
|
Singhal 2015 [30] India (lower-MIC) |
Intrinsically contaminated IV granisetron medicine vials used in adults | Burkholderia cepacia |
|
Guducuoglu 2016 [31] Türkiye (upper-MIC) |
TPN used in pediatrics | Candida albicans |
|
Ikumapayi 2016 [32] The Gambia (LIC) |
mSDV of saline used in pediatrics | Serratia liquefaciens |
|
Jain 2016 [33] India (lower-MIC) |
mSDV of dextrose used to flush intravascular catheters used in neonates | Proteus mirabilis |
|
Paul 2016 [34] India (lower-MIC) |
mSDV of saline and dextrose used in neonates | Burkholderia cepacia |
|
Shrivastava 2016 [35] India (lower-MIC) |
Intrinsically contaminated IV caffeine citrate medicine vials used in neonates | Burkholderia cepacia |
|
Ari 2017 [36] Türkiye (upper-MIC) |
mSDV of saline used to dilute contrast agent used in myocardial scintigraphy in adults | Serratia liquefaciens |
|
Orsini 2018 [37] Chile (upper-MIC) |
Intrinsically contaminated ondansetron used in adults and pediatrics | Sarocladium kiliense |
|
Pillonetto 2018 [38] Brazil (upper-MIC) |
Intrinsically contaminated TPN |
Acinetobacter baumannii Phytobacter diazotrophicus |
| Intrinsically contaminated calcium gluconate | Rhizobium radiobacter | |
|
Cilli 2019 [39] Türkiye (upper-MIC) |
mSDV of IV propofol used in adults | Serratia marcescens |
|
Eshetu 2019 [40] Ethiopia (LIC) |
mSDV of IV fluid used in a neonate | Klebsiella oxytoca |
|
Okomo 2020 [41] The Gambia (LIC) |
mSDV of saline and dextrose used to reconstitute antibiotics mSDV of gentamicin and metronidazole used in neonates |
Burkholderia cepacia |
| Klebsiella pneumoniae | ||
|
Arjun 2021 [42] Türkiye (upper-MIC) |
Intrinsically contaminated IV furosemide medicine ampoules used in adults | Achromobacter denitrificans Achromobacter xylosoxidans |
|
Garza-Gonzalez 2021 [43] Mexico (upper-MIC) |
Intrinsically contaminated TPN used in neonates | Leclercia decarboxylata |
|
Jaber 2021 [44] Morocco (lower-MIC) |
mSDV of propofol used in adults | Klebsiella oxytoca |
|
Murugesan 2021 [45] India (lower-MIC) |
Intrinsically contaminated IV diltiazem medicine used in adults | Burkholderia contaminans |
|
Tunccan 2021 [46] Türkiye (upper-MIC) |
Intrinsically contaminated IV saline bottles used in pediatrics and adults | Ralstonia solanacearum |
|
Ergenc 2022 [47] Türkiye (upper MIC) |
mSDV of propofol used in adults | Serratia marcescens |
|
Moukafih 2022 [48] Morocco (lower-MIC) |
mSDV of propofol used in pediatrics | Enterobacter cloacae |
|
Rajachandaran 2022 [49] India (lower-MIC) |
Intrinsically contaminated IV fentanyl medicine vials used in adults | Ralstonia pickettii |
|
Sridharan 2022 [50] India (lower-MIC) |
Intrinsically contaminated diltiazem vials used in adults | Burkholderia cepacia |
|
Fomda 2023 [51] India (lower-MIC) |
mSDV saline used to flush intravascular catheters used in adults | Burkholderia cepacia |
The numbers of pathogens and products exceed the number of articles because in some articles more than one pathogen was isolated and/or more than one product was reported
IV intravenous, LIC low-income country, Lower-MIC lower middle-income country, Upper-MIC upper middle-income country, mSDV multiple-use single-dose vials, i.e. medicine vials designed and manufactured as SDV, which are incorrectly used more than once and/or for more than one patient and IV fluids which are used for administration of multiple doses against the instructions of the manufacturer; TPN total parenteral nutrition
The symbol * refers to articles included in a previous review [3]. Infusates of dextrose and glucose IV fluids are both referred to as “dextrose.” The table mentions “intrinsic” in case of culture-proven contamination of sealed unopened products; the remaining products were extrinsically contaminated or had no specified information about the contamination pathway. The ward and patients involved, and age group of the patients were mentioned whenever information was provided