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Pyrogenic Reactions Associated With Single Daily Dosing of Intravenous Gentamicin

Published online by Cambridge University Press:  02 January 2015

Udo Buchholz ,
Chesley Richards ,
Rekha Murthy ,
Matthew Arduino ,
Doreen Pon ,
Wayne Schwartz ,
Elsie Fontanilla ,
Clare Pegues ,
Noemy Boghossian  and
Carol Peterson
...Show all authors
Udo Buchholz
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Acute Communicable Disease Control, Los Angeles County Department of Health Services, Los Angeles, California
Chesley Richards*
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Rekha Murthy
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
Matthew Arduino
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Doreen Pon
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
Wayne Schwartz
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
Elsie Fontanilla
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
Clare Pegues
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
Noemy Boghossian
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, California
Carol Peterson
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Health Services, Los Angeles, California
Jacob Kool
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Health Services, Los Angeles, California
Laurene Mascola
Affiliation:
Acute Communicable Disease Control, Los Angeles County Department of Health Services, Los Angeles, California
William R. Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Hospital Infections Program, Mailstop A-07, 1600 Clifton Rd, Atlanta, GA 30333
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Abstract

Objective:

To identify risk factors associated with an unexpected outbreak of pyrogenic reactions (PR) following intravenous gentamicin.

Design:

We conducted two cohort studies. PRs were defined as chills, rigors, or shaking within 3 hours after initiating the gentamicin infusion during the preepidemic (December 1, 1997-January 15,1998) or epidemic (May 1-June 15,1998) periods. We tested gentamicin vials for endotoxin using the limulus amebocyte lysate assay.

Setting:

Inpatient services of a large community hospital in Los Angeles, California.

Results:

During the epidemic period, 22 (15%) of 152 patients developed documented PRs following intravenous gentamicin. PRs were more likely among patients receiving single daily dosing (SDD) than multiple daily dosing gentamicin (20/73 [27%] vs 2/79 [3%]; relative risk, 10.8; 95% confidence interval, 2.644.7). Laboratory analysis of gentamicin vials found endotoxin levels that were higher among Fujisawa-brand gentamicin (implicated brand) than gentamicin used after the outbreak terminated (non-implicated brand). Although endotoxin levels in the vials did not exceed US Pharmacopeia limits (1.7 endotoxin units/mg gentamicin), the use of SDD gentamicin may place patients at greater risk of receiving doses of endotoxin above the threshold for PRs in humans.

Conclusions:

Reassessment of the acceptable amounts of endotoxin in gentamicin and other parenteral products should be considered when dosing intervals used in clinical practice change.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 12 , December 2000 , pp. 771 - 774
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1.Nicolau, DP, Freeman, CD, Belliveau, PP, Nightingale, CH, Ross, JW, Quintiliani, R. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients. Antimicrob Agents Chemother 1995:39:650–655.CrossRefGoogle Scholar
2.Deamer, RL, Dial, LK. The evolution of aminoglycoside therapy: a single daily dose. Am Fam Physician 1996;53:1782–1786.Google ScholarPubMed
3.Centers for Disease Control and Prevention. Endotoxin-like reactions associated with intravenous gentamicin—California, 1998. MMWR 1998;47:877–880.Google Scholar
4.Arduino, MJ, Bland, LAMcAllister, SK, Aguero, SM, Villarino, ME, McNeil, MM, et al. Microbial growth and endotoxin production in the intravenous anesthetic propofol. Infect Control Hosp Epidemiol 1991;12:535–539.CrossRefGoogle ScholarPubMed
5.Beck-Sague, CM, Jarvis, WR, Bland, LAArduino, MJ, Aguero, SM, Verosic, G. Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center. Am J Nephrol 1990;10:397–403.CrossRefGoogle Scholar
6.Pegues, DAOettinger, CW, Bland, LAOliver, JC, Arduino, MJ, Aguero, SM, et al. A prospective study of pyrogenic reactions in hemodialysis patients using bicarbonate dialysis fluids filtered to remove bacteria and endotoxin. Am Soc Nephrol 1992;3:1002–1007.CrossRefGoogle ScholarPubMed
7.Burrell, R. Human responses to bacterial endotoxin. Circ Shock 1994;43:137–153.Google ScholarPubMed
8.Suffredini, AF, Fromm, RE, Parker, MM, Brenner, M, Kovacs, JA, Wesley, RAet al. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 1989;321:280–287.CrossRefGoogle Scholar
9.Elin, RJ, Wolff, SM, McAdam, KP, Chedid, L, Audibert, F, Bernard, C, et al. Properties of reference Escherichia coli endotoxin and its phthalylated derivative in humans. J Infect Dis 1981;144:329–336.CrossRefGoogle ScholarPubMed
10.Hochstein, HD, Fitzgerald, EAMcMahon, FG, Vargas, R. Properties of US standard endotoxin (EC-5) in human male volunteers. J Endotoxin Res 1994;1:52–56.CrossRefGoogle Scholar
11.Novitsky, TJ, Roslansky, PF, Siber, GR, Warren, HS. Turbidimetric method for quantifying serum inhibition of the Limulus amoebocyte lysate. Clin Microbiol 1985;20:211–216.CrossRefGoogle Scholar
12.Krieger, JADuncan, L. Gentamicin contaminated with endotoxin. N Engl J Med 1999;340:11–22.CrossRefGoogle ScholarPubMed