MONTGOMERY, Ala. - An investigation found infections linked to contaminated intravenous feeding bags could have begun two months before officials realized there was a widespread problem at Alabama hospitals, the head of the state health agency said Wednesday.
Nine people died and 10 others were sickened this month after receiving nourishment from the kits. But because all the patients were already seriously ill, investigators may not ever be able to determine whether the IV feeding liquid contaminated with bacteria was to blame for the deaths and illnesses, said Dr. Donald Williamson, director of the Alabama Department of Public Health.
Williamson said two hospitals reported increased cases of bacteria called serratia marcescens to the state March 16. CBS News correspondent Mark Strassmann reports it is a part of a class of five deadly bacteria wreaking havoc in hospitals across the country, now responsible for 60 percent of all intensive-care infections. One in 20 patients develop these infections. In 2009, it's estimated 50,000 people died from them.
There was a single incident in January, but officials didn't notice a pattern until this month. Officials have not released the names or illnesses of the patients who were sickened. However, patients who typically use the IV feeding liquid have severe illnesses, including gastrointestinal diseases or are chemotherapty patients, Williamson said.
Officials believe the outbreak was linked to one batch of feeding liquid produced at a Birmingham-area laboratory of Meds IV, and all the contaminated material has been recalled.
"From what we know right now it is a closed circle," Williamson said.
Officials with Meds IV, which was formed last year and is based in a Birmingham office park, did not respond to telephone calls and messages. The company website says it provides sterile products to hospital pharmacies, surgery centers and doctor offices.
"Our staff of pharmacists has over 50 years of sterile product admixing experience," the website says.
Problems were first detected at Shelby Baptist Medical Center in the Birmingham suburb of Alabaster, where two patients died and three others were infected after receiving TPN, a common nutritional supplement delivered directly from the plastic bags into the bloodstream through IV tubes. Seven patients were infected at Baptist Princeton, and four of them died.
"We have terminated our relationship with the supplier and, as a precaution, we have removed all other products from the supplier from the pharmacy stock in our hospitals," said a statement by Dr. Elizabeth D. Ennis, chief medical officer for Baptist hospitals.
Officials linked the serratia marcescens infection to TPN produced by Meds IV.
Meds IV has notified its customers of the contamination, has discontinued production and was being very cooperative, he said.
Meds IV is registered to Edward Cingoranelli, who appears to have been involved in at least three other medical supply companies, according to the Alabama Secretary of State's office.
When Select Specialty Hospital in Birmingham learned one of its suppliers may have distributed bags containing the bacteria, it started investigating and stopped using Meds IV products, said Jeffrey Denney the hospital's chief executive officer. Other hospitals also immediately stopped using the products.
"We are committed to high-quality patient care and are fully cooperating with government officials in their ongoing investigation of the supplier," Denney said.
Hospitals have very strict infection control for TPN. The supplement compound of several different nutrients, including electrolytes, is delivered daily in bags that are pre-mixed, not done in the hospital. The supplement is administered into a central line intravenously, going directly into the patients' blood stream. Patients are monitored carefully for symptoms of septic shock.
Serratia marcescens bacteria grow in moist areas and can settle in hospital patients' respiratory and urinary tracts. The bacteria are common and easily treatable if detected early. Patients with serratia sepsis may have fever, chills, shock, and respiratory distress.
Other hospitals hit with the outbreak included Medical West and Cooper Green in the Birmingham area and Baptist Prattville, north of Montgomery.
The state health department, Centers for Disease Control and Prevention in Atlanta, and the Food and Drug Administration are investigating.
The CDC in 2005 identified the bacteria as causing blood stream infections in about a dozen patients in New Jersey and California that were treated with contaminated salt solutions administered through IVs from similar bags.