Sepsis outbreak associated with use of contaminated propofol: A new case series and literature review

Introduction. - Propofol is the most commonly used hypnotic agent for the induction and maintenance of general anesthesia. Due to its lipid-based composition, propofol requires a strict handling protocol to avoid an increased risk of extrinsic contamination. Methods. - On September 09, 2021, 05 patients with post-anaesthetic Enterobacter cloacaeinfections were identified in the pediatric exploration department of the Hassan II UniversityHospital of Fez in Morocco. We describe the investigation into this outbreak. All patient medicalrecords were reviewed to determine patient characteristics and potential risk factors. For theliterature review, we identified relevant articles by searching PubMed, Medline, Embase andScience Direct. Results. - Our study included five patients, 80% were boys. The average age was 4.6 years(1-7 years), with no medical history. All five patients underwent exploratory procedures. Immediately after the procedures, all 5 patients presented with chills, tachycardia and fever in thesame order of admission. They were all admitted to hospital and blood samples were taken. Blood cultures were positive for E. cloacae. All patients had elevated levels of C-reactive protein (CRP) and an elevated white blood cell count. Bacteriological investigation revealed that the infection was caused by extrinsic contamination of the intravenous anesthetic propofol by E. cloacae. Conclusion. - Fatal infections due to contaminated drugs, including propofol, have been reported worldwide. Propofol is a potential source of infections due to its lipophilic nature whichpromotes microbial growth. This probably remains an underestimated problem that deserves awareness for early recognition. (c) 2022 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.