HOSPITAL INFECTION OUTBREAK DUE TO ILLICIT DRUG USE

NEW YORK - Researchers from the US Centers for Disease Control and
Prevention (CDC) are reporting that 26 patients in an intensive care unit
at one hospital contracted a rare bacterial infection through infusions
with the pain killer fentanyl.

The infusions are believed to have been contaminated with Serratia
marcescens bacteria by a staff respiratory therapist who was apparently
taking the drug illicitly. Fentanyl is a powerful opiate narcotic 80 times
more potent than morphine.

Hospital administrators became concerned during the summer of 1998 when
nine patients became infected with S. marcescens. After initial testing
failed to identify the cause, and new infections were discovered, the CDC
was invited to assist in the investigation, which lasted until March 1999.

"We hypothesize that reuse of needles to remove fentanyl may have led to
inadvertent contamination," lead author Dr. Belinda E. Ostrowsky of the CDC
and colleagues report in the May 16th issue of The New England Journal of
Medicine.

Suspicious activity by a male respiratory therapist spurred investigators
to interview many of the hospital workers associated with the intensive
care patients.

While an analysis of a hair sample from the respiratory therapist contained
fentanyl, "documenting recent ingestion, injection or infusion of
fentanyl," he denied any illicit use of the drug. Nonetheless, after this
staff member was fired, there were no further cases of S. marcescens, the
researchers report.

"Theft of narcotics and the potential for resulting complications in
patients remain a problem in healthcare settings," the authors write.

"The episode described here might initially appear to be an isolated event
related to poor judgment on the part of an employee. However, this outbreak
persisted for more than 9 months, with a large group of hospitalized
patients potentially at risk," they add.

The findings "underscore the risk of serious complications in patients that
is associated with illicit narcotic use by healthcare workers," Ostrowsky
and colleagues conclude.

SOURCE: The New England Journal of Medicine 2002;346:1529-1537.