RESUMEN
Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck's Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products.
Asunto(s)
Ceguera/microbiología , Endoftalmitis/microbiología , Infecciones Fúngicas del Ojo/microbiología , Soluciones Oftálmicas/efectos adversos , Colorantes de Rosanilina/efectos adversos , Triamcinolona Acetonida/efectos adversos , Anciano , Anciano de 80 o más Años , Ceguera/epidemiología , Ceguera/etiología , Ceguera/cirugía , Recall de Medicamento , Endoftalmitis/epidemiología , Endoftalmitis/etiología , Endoftalmitis/cirugía , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/etiología , Infecciones Fúngicas del Ojo/cirugía , Femenino , Fusarium/patogenicidad , Fusarium/fisiología , Humanos , Masculino , Persona de Mediana Edad , Retina/microbiología , Retina/patología , Retina/cirugía , Saccharomycetales/patogenicidad , Saccharomycetales/fisiología , Estados Unidos/epidemiología , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/patología , Cuerpo Vítreo/cirugíaRESUMEN
BACKGROUND: A birth dose of hepatitis B vaccine (HBV) is a primary focus of the Advisory Committee on Immunization Practices' strategy to eliminate transmission of hepatitis B virus in the United States. We sought to assess the impact of maternal characteristics and hospital policy on the receipt of a birth dose of HBV. METHODS: A retrospective cohort study was performed using data from the 2008 Colorado birth registry. Hospital policy was assessed by state health department personnel. Univariate and multivariate logistic regression analyses were used to examine the association of maternal characteristics and hospital policy with nonreceipt of HBV. RESULTS: A total of 64,425 infants were identified in the birth cohort, of whom 61.6% received a birth dose of HBV. Higher maternal education and income were associated with nonreceipt of HBV (master's degree vs. eighth grade or less: adjusted odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.49-1.85; >$75,000 vs. <$15,000: adjusted OR = 1.21, 95% CI = 1.13-1.30). Lack of a hospital policy stipulating a universal birth dose strongly predicted nonreceipt of a birth dose of HBV (policy with no birth dose vs. policy with a birth dose: adjusted OR = 2.21, 95% CI = 2.13-2.30). CONCLUSIONS: Maternal characteristics such as higher education and income are associated with nonreceipt of the HBV during the perinatal period. To effectively reduce risk of perinatal hepatitis B transmission, hospitals should stipulate that all infants are offered HBV and ensure that these policies are implemented and followed.