PURPOSE: The production and administration of drugs used intrathecally requires special care to prevent contamination with @entity2359 agents. In 2007, we investigated a widespread outbreak of @entity451 and @entity1746 among Chinese @entity1 who received intrathecal drugs to identify the presumed contaminant and its source to prevent further cases. @entity1 AND METHODS: We defined a case as onset from January 1 to October 31, 2007, of bilateral flaccid @entity1746 or @entity451 or retention and incontinence of stool or urine, in a @entity1 receiving intrathecal drugs. Using a retrospective cohort approach, we selected 12 hospitals from all hospitals that had reported cases. In these hospitals, we identified all 448 @entity1 (including 107 cases) who received intrathecal chemotherapy or chemoprophylaxis in 2007. We calculated attack rates and Mantel-Haenszel adjusted risk ratios for intrathecal drug type and lot. RESULTS: All 12 hospitals used intrathecal @entity1499 or @entity2592 produced by one pharmaceutical plant. Only two lots of each drug were associated with cases. Lot-specific attack rates ranged from 42% to 100% (risk ratio,    ; lower confidence bounds, 1.8 to 7.3). @entity1891 production had immediately preceded production of the implicated lots on the same equipment. By using ultra performance liquid chromatography, we detected @entity1891 (0.28 to 18  g) in unused vials from implicated lots of @entity1499 and @entity2592 . CONCLUSION: Trace amounts of @entity1891 that contaminated intrathecal drugs caused a large outbreak of severe @entity16 . @entity1891 and other @entity2359 drugs should not be produced on any equipment that is also used for producing drugs that are to be administered intrathecally.

@entity451 and @entity1746 from intrathecal @entity1499 and XXXX contaminated with trace amounts of @entity1891 in China during 2007.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'PATIENTS'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurologic damage'] @entity1746 :: ('MESH:D020335', 'Disease') :: ['paraparesis'] @entity2592 :: ('MESH:D003561', 'Chemical') :: ['cytarabine'] @entity1891 :: ('MESH:D014750', 'Chemical') :: ['Vincristine', 'vincristine'] @entity451 :: ('MESH:C536857', 'Disease') :: ['paraplegia'] @entity1499 :: ('MESH:D008727', 'Chemical') :: ['methotrexate'] @entity2359 :: ('MESH:D020258', 'Disease') :: ['neurotoxic']
@entity2592 :: (MESH:D003561,Chemical) :: ['cytarabine']
