Proliferation of klebsiella pneumoniae in medication containing vials for multiple dose medication and intravenous fluids.

Abstract

Background and objectives: Klebsiella pneumoniae is frequently implicated in healthcare associated infections. This organism is non–fastidious and easily transmitted in a healthcare environment. Medication fluids are an ideal vehicle for transmission of these organisms. This study aimed to determine if K. pneumoniae would proliferate in various medication fluids. Method: The behaviour of K. pneumoniae was studied in piperacillin/tazobactam, ciprofloxacin, meropenem, insulin, heparin, lignocaine, and gentamicin, concentrations (50-2 %) of dextrose, Neonatalyte® and saline. This was assessed over a 24-hour period at 25 oC and 35 oC. Results: K. pneumoniae did not proliferate in the antibiotics or the multi-dose vials. The bacteria persisted in Neonatalyte® and saline. Bactericidal activity was observed in 50 %, 25 % and 12.5 % dextrose at both incubation temperatures. In 10 %, at 24 hours post inoculation, a decrease of 57 % and 50 % was observed at 25 oC and 35 oC respectively. At concentrations of 6 %, 3 % and 2 %, after 24 hours post inoculation at 25 oC, the colony count increased by 112 %, 124 % and 133 % and at 35 oC by 120 %, 134 % and 150 % respectively. There was no difference in the behaviour of K. pneumoniae at 25 oC and 35 oC. Neonatalyte® and saline demonstrated no increase in the cfu/mL over 24 hours. Conclusions: Persistence of the test bacteria in saline, neonatalyte and lower concentrations of dextrose has been shown. This poses serious risk to patient care if the bacteria inadvertently enter the fluid due to infection prevention breeches.