Nationwide Epidemic of Septicemia Caused by Contaminated Infusion Products. IV. Growth of Microbial Pathogens in Fluids for Intravenous Infusion

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Abstract
Septicemia caused by contaminated infusion fluid is a newly appreciated hazard of intravenous infusion therapy. Microorganisms of the tribe Klebsielleae (Klebsiella, Enterobacter, and Serratia) have predominated in these infections. Members of this tribe were found to possess a selective ability over common non-Klebsielleae microbial pathogens to proliferate rapidly in commercial parenteral fluids containing glucose at room temperature. Fifty-one Klebsielleae strains, washed twice before inoculation of approximately 1 organism/ml, attained a mean normalized 24-hr concentration of 1.11 × 105 organisms/ml in 5% dextrose in water at 25 C. In contrast, 48 of 49 non-Klebsielleae bacterial strains (clinical isolates of Staphylococcus, Proteus, Escherichia coli, Herellea, and Pseudomonas aeruginosa) slowly died (mean 24-hr concentration, 0.2 organism/ml). Five Candida albicans strains grew only very slowly (31.3 organisms/ml). Even with concentrations exceeding 106 organisms/ml, microbial presence was never visibly detectable. The significant increase in cases of nosocomial septicemia caused by Klebsiella. Enterobacter, and Serratia in recent years might be attributable in part to fluid-related sepsis accompanying the expanding use of parenteral therapy.

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