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An Outbreak of Klebsiella pneumoniae and Enterobacter aerogenes Bacteremia After Interventional Pain Management Procedures, New York City, 2008
  1. Melissa R. Wong, MPH*,,
  2. Paula Del Rosso, RN*,
  3. Lisa Heine, MS, RN,
  4. Veronica Volpe, RN,
  5. Lillian Lee, MS§,
  6. John Kornblum, PhD§,
  7. Ying Lin, PhD§,
  8. Marcelle Layton, MD* and
  9. Don Weiss, MD, MPH*
  1. From the *Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, NY;
  2. Council of State and Territorial Epidemiologists, Atlanta, GA; and
  3. Clinical Quality Management and Improvement,and
  4. §Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, NY.
  1. Address correspondence to: Don Weiss, MD, MPH, 125 Worth St, CN-22A, New York, NY 10013 (e-mail: dweiss{at}


Background and Objectives: In October 2008, an investigation was conducted into a cluster of gram-negative bloodstream infections after invasive pain management procedures at an outpatient facility to identify additional cases and determine the source of illness.

Methods: We conducted a retrospective cohort study to determine exposures associated with illness. Eligible patients had an invasive procedure in the 4 days before or after the procedure date of the initial case-patients. Infection control assessments were made, and environmental specimens collected.

Results: Four laboratory-confirmed case-patients (3 with Klebsiella pneumoniae and 1 with Enterobacter aerogenes) and 5 suspect case-patients were identified. In addition to the 9 confirmed and suspect case-patients, 45 patients were interviewed. All confirmed and suspect case-patients had a sacroiliac joint steroid injection procedure; injection into the sacroiliac joint was associated with illness (9/22 versus 0/31; P < 0.0001). Multiple breaches in infection control were noted including the reuse of single-use vials for multiple patients. The 3 K. pneumoniae with positive blood cultures were indistinguishable by pulse-field gel electrophoresis, and the E. aerogenes-positive blood culture was indistinguishable by pulse-field gel electrophoresis to the culture from an open vial of 100-mL iodixanol contrast solution.

Conclusion: Infection was associated with pain management procedures, specifically those involving injection to the sacroiliac joint. Lapses in infection control likely led to the contamination of single-use vials that were then used for multiple patients. Reuse of medication vials should be restricted, and affordable single-dose vials should be made available.

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  • This work was conducted by the New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Public Health Laboratory, Clinical Quality Management and Improvement, New York, NY.

  • There are no financial sources for this study.