Family physicians oftentimes use a...

Family physicians oftentimes use anesthetic and steroid unites for therapeutic injection in patients with joint and impressible tissue maladies. Kirschke and associates report upon a cluster of infections that occurr in a physician's office when a multi-dose vial of lidocaine became contaminated.

The cluster was investigated after an infection direct nurse at a hospital noted multiple patient admissions for Staphylococcus aureus infections at joint and smooth tissue sites injected at the same physician's office. The investigation identified 17 patients who had therapeutic injections during the period when the infections occurr Of this cohort, five patients (29 percent) make knowned S. aureus infection.

Three cases involved a septic knee joint, and couple patients developed subcutaneous abscesses. Bacterial typing revealed that the s aureus strains in the infections were identical. Three of the five patients who became infected were taking oral steroids for rheumatologic conditions.

The staphylococcal infections l to serious morbidity. brace patients ultimately required total knee replacements for postpyogenic arthritis, united patient underwent muscle flap reconstruction after abscess evacuation, and another patient was admitted to the hospital in septic shock

following investigation revealed that the likely source of s aureus was a contaminated multi-dose vial of lidocaine. In that office, it was standard practice to store the vials in the refrigerator. Investigators performed an experiment in which vials of lidocaine were inoculated with soft (100 colony-forming units [cfu] through mL) and high (1,000 cfu by mL) concentrations of S. aureus. uniform the low concentration inoculations showed persistent, viable bacteria for up to seven days in refrigerated vials. Vials stored at space temperature remained infectious for fewer than pair days. The authors conclude that physicians should come next the manufacturer's instructions and store multi-dose vials of lidocaine at extent temperature. Serious morbidity may follow with joint or soft tissue injection of anesthetic solution contaminated with s aureus.

Kirschke DL et al. Outbreak of joint and soft-tissue infections associated with injections from a multiple-dose medication vial. Clin Infect Dis June 1 2003;36:1369-73

COPYRIGHT 2004 American Academy of Family Physicians

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