BACKGROUND: From June 30, 1998, through March 21, 1999, several @entity1 in the surgical intensive care unit of a hospital acquired @entity5134 @entity2259 . We investigated this outbreak. METHODS: A case was defined as the occurrence of @entity5134 @entity2259 in any @entity1 in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared @entity1 with @entity5134 @entity2259 with randomly selected controls. Isolates from @entity1 and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for @entity3575 . RESULTS: Twenty-six @entity1 with @entity5134 @entity2259 were identified; eight (31 percent) had polymicrobial @entity2259 , and seven of these had @entity7100 and @entity5134 in the same culture. According to univariate analysis, @entity1 with @entity5134 @entity2259 stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received @entity3575 in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of @entity3575 and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P=0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with @entity3575 ; his hair sample tested positive for @entity3575 . Cultures of @entity3575 infusions from two case @entity1 yielded @entity5134 and @entity7100 . The isolates from the case @entity1 and from the @entity3575 infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. CONCLUSIONS: An outbreak of @entity5134 and @entity7100 @entity2259 in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic @entity3575 by a health care worker. Our findings underscore the risk of complications in @entity1 that is associated with illicit narcotic use by health care workers.

XXXX @entity2259 traced to an infused narcotic.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity5134 :: ('615', 'Species') :: ['Serratia marcescens', 'S. marcescens'] @entity3575 :: ('MESH:D005283', 'Chemical') :: ['fentanyl'] @entity7100 :: ('550', 'Species') :: ['Enterobacter cloacae', 'E. cloacae'] @entity2259 :: ('MESH:D016470', 'Disease') :: ['bacteremia']
@entity5134 :: (615,Species) :: ['Serratia marcescens']
