Abstract
Purpose
To evaluate the ability of the EmulSiv™ filter (EF) to remove extrinsic microbial contaminants from propofol.
Methods
Aliquots of Staphylococcus aureus (S. aureus), Candida albicans (C. albicans), Klebsiella pneumoniae (K. pneumoniae), Moraxella osloensis (M. osloensis), Enterobacter agglomerans (E. agglomerans), Escherichia coli (E. coli), Serratia marcescens (S. marcescens), Moraxella catarrhalis (M. catarrhalis), Haemophilus influenzae (H. influenzae) and Campylobacter jejuni (C. jejuni) were inoculated into vials containing 20 mL of sterile propofol. The unfiltered inoculated propofol solutions served as controls. Ten millilitres and 20 mL samples of the inoculated propofol were filtered through the EF. All solutions were then subplated onto three culture plates using a precision 1 μL calibrated platinum loop and incubated. The number of colony forming units (CFU) were counted. Data were analyzed using a one-sample t test, and a P value of less than 0.05 was selected as the level of statistical significance.
Results
The EF was able to completely remove CFU of S. aureus, C. albicans, K. pneumoniae, M. osloensis, E. agglomerans, E. coli, S. marcescens, and M. catarrhalis (P < 0.05). A small number of H. influenzae CFU were able to evade filtration in both the 10 mL and 20 mL samples. C. jejuni CFU were able to evade filtration in only the 10 mL sample.
Conclusions
The EF removes the majority of microbial contaminates from propofol with the exception of H. influenzae and C. jejuni. Although the EF is capable of removing most of the microbial contamination produced by H. influenzae and C. jejuni, a few CFU are capable of evading filtration. Consequently, even the use of a filter capable of removing microbial contaminants is not a substitute for meticulous aseptic technique and prompt administration when propofol is used.
Résumé
Objectif
Évaluer la capacité du filtre EmulSiv™ (FE) à éliminer les contaminants microbiens extrinsèques du propofol.
Méthode
Des aliquots de Staphylococcus aureus (S. aureus), Candida albicans (C. albicans), Klebsiella pneumoniae (K. pneumoniae), Moraxella osloensis (M. osloensis), Enterobacter agglomerans (E. agglomerans), Escherichia coli (E. coli), Serratia marcescens (S. marcescens), Moraxella catarrhalis (M. catarrhalis), Haemophilus influenzae (H. influenzae) et Campylobacter jejuni (C. jejuni) ont été inoculées dans des fioles contenant 20 mL de propofol stérile. Des solutions de propofol non filtré, inoculées, ont servi de témoins. Des échantillons de 10 et 20 mL de propofol inoculé ont été passés au travers du FE. Toutes les solutions ont été ensemencées sur trois plaques à culture en utilisant une anse de platine calibrée à 1 μL de précision. Le nombre de colonies a été compté. Les données ont été analysées par le test t pour un échantillon et une valeur de P plus petite que 0,05 a été choisie comme statistiquement significative.
Résultats
Le FE a permis d’éliminer complètement les colonies de S. aureus, C. albicans, K. pneumoniae, M. osloensis, E. agglomerans, E. coli, S. marcescens et M. catarrhalis (P < 0,05). Un petit nombre de colonies de H. influenzae a pu traverser le filtre dans les échantillons de 10 et de 20 mL. Les colonies de C. jejuni n’ont traversé que le filtre dans les échantillons de 10 mL.
Conclusion
Le FE élimine la majorité des contaminants microbiens du propofol, sauf ceux du H. influenzae et du C. jejuni. Bien que le FE soit capable d’éliminer presque tous les contaminants microbiens produits par le H. influenzae et le C. jejuni, quelques colonies ont pu traverser le filtre. Par conséquent, même l’usage d’un filtre capable d’éliminer les contaminants microbiens ne peut se substituer à une technique aseptique méticuleuse et à l’administration précoce dans le cas du propofol.
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References
Morgan GE Jr, Mikhail MS. Anesthetic complications.In: Morgan GE Jr, Mikhail MS (Eds.). Clinical Anesthesiology, 2nd ed. New York: Lange Medical Books/McGraw Hill; 1996: 760.
Carr S, Waterman S, Rutherford G, et al. Postsurgical infection associated with an extrinsically contaminated intravenous anesthetic agent-California, Illinois, Maine and Michigan. MMWR Mor Mortal Wkly Rep 1990; 39: 426–7, 433.
Bennett SN, McNeil MM, Bland LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995; 333: 147–54.
Gillis MC. Diprivan®.In: Gillis MC, (Ed.). Compendium of Pharmaceuticals and Specialties 34th ed. Ottawa, Ontario: Pharmacists Association; 1999: 539–43.
Nichols R, Smith J. Bacterial contamination of an anesthetic agent (Editorial). N Engl J Med 1995; 333: 184–5.
Veber B, Gachot B, Bedos JP, Wolff M. Severe sepsis after intravenous injection of contaminated propofol (Letter). Anesthesiology 1994; 80: 712–13.
Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH. Manual of Clinical Microbiology, 7th ed. Washington: D.C., ASM Press; 1999.
Holt JG, Krieg NR, Sneath PHA, Staley JT, Willliams ST. Bergey’s Manual of Determinative Bacteriology 9th ed. Baltimore: Williams and Wilkins; 1994.
Nachamkin I. Campylobacter and acrobacter.In: Murray PR, Baron EJ, Pfaller MA, Tennover FC, Yolken RH (Eds.). Manual of Clinical Microbiology, 7th ed. Washington: ASM Press; 1999: 716–26.
Carbone-Traber KB, Shanks CA. Glass particle contamination in single-dose ampules. Anesth Analg 1986; 65: 1361–3.
Goodale DB. Propofol: can a single ampule be used for multiple patients? (Letter reply) Anesthesiology 1991; 74: 1156–7.
McHugh GJ, Roper GM. Propofol emulsion and bacterial contamination. Can J Anaesth 1995; 42: 801–4.
Zacher AN, Zornow MH, Evans G. Drug contamination from opening glass ampules. Anesthesiology 1991; 75: 893–5.
Kempen PM, Sulkowski E, Sawyer RA. Glass ampules and associated hazards. Crit Care Med 1989; 17: 812–3.
Bach A, Motsch J. Infectious risks associated with the use of propofol. Acta Anaesthesiol Scand 1996; 40: 1189–96.
Webb SAR, Roberts B, Breheny FX, Golledge CL, Cameron PD, Van Heerden PV. Contamination of propofol infusions in the intensive care unit: incidence and clinical significance. Anaesth Intensive Care 1998; 26: 162–4.
Bach A, Motsch J, Schmidt H, et al. In-use contamination of propofol. A clinical study. Eur J Anaesthesiol 1997; 14: 178–83.
Lorenz IH, Kolbitsch C, Lass-Florl C, et al. Routine handling of propofol prevents contamination as effectively as does strict adherence to the manufacturer’s recommendations. Can J Anesth 2002; 49: 347–52.
Kolbitsch C, Lass-Florl C, Benzer A. Propofol and post-operative infections. (Letter). N Engl J Med 1995; 333: 1506–7.
Rosenberg AD, Bernstein RL, Ramanathan S, Albert DB, Marshall MH. Do anesthesiologists practice proper infection control precautions? Anesthesiology 1989; 71(Suppl): A949.
Kempen PM, Learned DW. Anesthesia practice - a vector of infection? Anesthesiology 1989; 71(Suppl): A948.
Barnett M, Cohen J. Filtration of lipid containing total parenteral nutrition (TPN) admixtures. Clinical Nutrition 1995; 14: 49.
Jarvis WR, Highsmith AK. Bacterial growth and endotoxin production in lipid emulsion. J Clin Microbiol 1984; 19: 17–20.
Arduino MJ, Bland LA, McAllister SK, et al. Microbial growth and endotoxin production in the intravenous anesthetic propofol. Infect Control Hosp Epidemiol 1991; 12: 535–9.
Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994; 271: 1598–601.
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Sources of funding: No funding for this project was provided by the University of Alberta Hospitals, the Royal Alexandra Hospital, the Departments of Anesthesiology and Pain Medicine nor the Pall Biomedical Products Company. The authors provided the funds needed to conduct this study.
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Hall, W.C.E., Jolly, D.T., Hrazdil, J. et al. The EmulSiv™ filter removes microbial contamination from propofol but is not a substitute for aseptic technique. Can J Anesth 50, 541–546 (2003). https://doi.org/10.1007/BF03018637
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DOI: https://doi.org/10.1007/BF03018637