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FDA - Multistate outbreak of fungal meningitis and other infections - Bacterial and/or fungal contaminants identified in additional NECC products; UPD

Catbird

Senior Moderator
(NOTE: Format edited for clarity.)


Multistate outbreak of fungal meningitis and other infections

Update on NECC Products: Samples of betamethasone and cardioplegia solution test positive for bacterial contamination​

[11-01-2012] The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are reporting laboratory results from samples of two additional recalled NECC products – preservative free betamethasone and cardioplegia solution. Previously, the fungus Exserohilum rostratum was identified in NECC-supplied, preservative-free methylprednisolone acetate (MPA).

The FDA and CDC laboratories have identified bacteria present in three separate lots (batches) of NECC-supplied preservative-free betamethasone, with each lot producing different culture results, and in a single lot of NECC cardioplegia solution.



Product and Lot Number
Betamethasone 08202012@141

Microbial Identification:
Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp.



Product and Lot Number:
Betamethasone 07032012@22

Microbial Identification:
Bacillus niabensis, Bacillus circulans



Product and Lot Number:
Betamethasone 07302012@52

Microbial Identification:

Bacillus lentus, Bacillus circulans



Product and Lot Number:
Cardioplegia solution 09242012@55

Microbial Identification:
Bacillus halmapalus, Brevibacillus choshinensis


The clinical significance of these results is not known. Both Bacillus idriensis and Bacillus circulans have been rarely reported as a cause of human disease. CDC continues to investigate reports of potential infections in patients receiving other NECC products. As of Nov. 1, CDC has not received reports of laboratory-confirmed cases of infection due to Bacillus or closely related organisms linked to betamethasone or cardioplegia solution from NECC.

Fungal cultures for betamethasone and cardioplegia solution are pending and the presence of additional microbial organisms and/or fungus in these products cannot be ruled out at this time.

Although final laboratory results on additional samples are still pending, the previous finding of fungal contamination of MPA and recent finding of bacterial contamination of betamethasone and cardioplegia solution reinforce the FDA’s concern about the lack of sterility in products produced at NECC’s compounding facility and serve to underscore that hospitals, clinics, and health care providers should not use any NECC-supplied products. All NECC products are subject to NECC’s recall announced on Oct. 6, 2012.

As previously confirmed by the CDC and FDA, the fungus Exserohilum rostratum was identified from 2 different lots of NECC-supplied, preservative-free MPA (Lot #06292012@26 and Lot #08102012@51), which have been associated with the outbreak of fungal meningitis and other infections in patients. Testing on the third implicated lot of MPA (Lot #05212012@68), as well as other NECC products, is ongoing.

Health care professionals and patients may call the FDA's Drug Information Line at 855-543-DRUG (3784) and press * to get the most recent information regarding the Ameridose recall and speak directly to a pharmacist.

The FDA asks health care professionals and consumers to report any adverse reactions to the FDA's MedWatch Program by fax at 800-FDA-0178, by mail at MedWatch, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787, or on the MedWatch website at www.fda.gov/medwatch.
 
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Re: FDA - Multistate outbreak of fungal meningitis and other infections - 2 additional NECC products test positive for bacterial contamination

Re: FDA - Multistate outbreak of fungal meningitis and other infections - 2 additional NECC products test positive for bacterial contamination

The FDA website has been updated to include the following NEW information. (NOTE from CB: New information shown in red.)

Updated excerpt from:

Multistate outbreak of fungal meningitis and other infections​

Update on NECC Products: Samples of injectable betamethasone and cardioplegia solution test positive for bacterial contamination


[11-02-12] *The chart is updated to include additional species of Bacillus bacteria.

[11-01-2012] The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) are reporting laboratory results from samples of two additional recalled NECC products ? preservative-free injectable betamethasone and cardioplegia solution. Previously, the fungus Exserohilum rostratum was identified in NECC-supplied, preservative-free methylprednisolone acetate (MPA).

The FDA and CDC laboratories have identified bacteria present in three separate lots (batches) of NECC-supplied preservative-free injectable betamethasone, with each lot producing different culture results, and in a single lot of NECC cardioplegia solution.


Product and Lot Number
Betamethasone 6 mg/mL injectable ? 5 mL per vial 08202012@141

Microbial Identification:
Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp., *Bacillus niacini



Product and Lot Number:
Betamethasone 6 mg/mL injectable ? 5 mL per vial 07032012@22

Microbial Identification:
Bacillus niabensis, Bacillus circulans



Product and Lot Number:
Betamethasone 12 mg/mL injectable ? 5 mL per vial 07302012@52

Microbial Identification:
Bacillus lentus, Bacillus circulans, Bacillus niabensis, Paenibacillus barengoltzii/timonensis



Product and Lot Number:
Cardioplegia solution 265.5 mL per bag 09242012@55

Microbial Identification:
Brevibacillus choshinensis, *Bacillus halmapalus/horikoshii, Brevibacillus choshinensis (NOTE from CB: Bacillus halmapalus has been removed and replaced with *Bacillus halmapalus/horikoshii)
 
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Re: FDA - Multistate outbreak of fungal meningitis and other infections - 2 additional NECC products test positive for bacterial contamination

Re: FDA - Multistate outbreak of fungal meningitis and other infections - 2 additional NECC products test positive for bacterial contamination

FDA update on NECC products. New information is marked with **.

Excerpt from:

Multistate outbreak of fungal meningitis and other infections​


Update on NECC Products: Samples of injectable betamethasone, injectable triamcinolone and cardioplegia solution test positive for microbial contamination

[11-20-2012] **The chart is updated to include new culture results


Medication
Betamethasone 6 mg/mL injectable – 5 mL per vial

Lot number
08202012@141

Microbial contamination
Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp., *Bacillus niacin, ** Koceria rosea, **Bacillus lentus



Medication
Betamethasone 6 mg/mL injectable – 5 mL per vial

Lot number
07032012@22

Microbial contamination
Bacillus niabensis, Bacillus circulans



Medication
Betamethasone 12 mg/mL injectable – 5 mL per vial

Lot number
07302012@52

Microbial contamination
Bacillus lentus, Bacillus circulans, *Bacillus niabensis, Paenibacillus barengoltzii/timonensis



Medication
**Betamethasone 6 mg/mL injectable – 5 mL per vial

Lot number
08202012@44

Microbial contamination
Bacillus lentus, Bacillus firmus, Bacillus pumilus



Medication
**Betamethasone 6 mg/mL injectable – 5 mL per vial

Lot number
08152012@84

Microbial contamination
Fungal growth – identification pending



Medication
**Triamcinolone 40 mg/mL injectable – 1 mL per vial

Lot number
06062012@6

Microbial contamination
Bacillus lentus, Bacillus circulans



Medication
**Triamcinolone 40 mg/mL injectable – 2 mL per vial

Lot number
08172012@60

Microbial contamination
Fungal growth – identification pending



Medication
**Triamcinolone 40 mg/mL injectable – 10 mL per vial

Lot number
08242012@2

Microbial contamination
Fungal growth – identification pending



Medication
Cardioplegia solution 265.5 mL per bag

Lot number
09242012@55

Microbial contamination
*Bacillus halmapalus/horikoshii, Brevibacillus choshinensis
 
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Re: FDA - Multistate outbreak of fungal meningitis and other infections - 2 additional NECC products test positive for bacterial contamination

Re: FDA - Multistate outbreak of fungal meningitis and other infections - 2 additional NECC products test positive for bacterial contamination

FDA: Multistate outbreak of fungal meningitis and other infections​


Update on NECC Products: Samples of injectable betamethasone, injectable triamcinolone and cardioplegia solution test positive for microbial contamination

[11-30-2012] FDA and CDC have identified bacterial and/or fungal contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC. These include bacteria known as Bacillus, and fungal species including Aspergillus tubingensis, Aspergillus fumigatus, Cladosporium species,and Penicillium species. Although rare, some of the identified Bacillus species can be human pathogens. Some of the fungal organisms identified, particularly Aspergillus fumigatus, are known to cause disease in humans. It is not known how product contamination with these organisms could affect patients clinically. See CDC?s Advice for Clinicians.


CDC and FDA Laboratory-Confirmed Organisms from Product Samples​

Laboratory-Confirmed Organisms from Product Samples Associated with
NECC Recalled Lots of Betamethasone, Cardioplegia, and Triamcinolone Solutions​


Medication- Betamethasone
6 mg/mL injectable ?5 mL per vial

Lot Number- 08202012@141

Bacterial and Fungal Contamination- Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp., Bacillus niacini, Kocuria rosea,
Bacillus lentus


Medication- Betamethasone
6 mg/mL injectable ?5 mL per vial

Lot Number- 07032012@22

Bacterial and Fungal Contamination- Bacillus niabensis, Bacillus circulans


Medication- Betamethasone
12 mg/mL injectable ? 5 mL per vial

Lot Number- 07302012@52

Bacterial and Fungal Contamination- Bacillus lentus, Bacillus circulans, Bacillus niabensis, Paenibacillus barengoltzii/timonensis


Medication- Betamethasone
6mg/mL injectable ? 5 mL per vial

Lot Number- 08202012@44

Bacterial and Fungal Contamination- Bacillus lentus, Bacillus firmus, Bacillus pumilus


Medication- Betamethasone
6 mg/mL injectable ? 5 mL per vial

Lot Number- 08152012@84

Bacterial and Fungal Contamination- Penicillium sp., Cladosporium sp.


Medication- Triamcinolone*
40mg/mL injectable ? 1 mL per vial
*Other identification of bacteria are pending for this product

Lot Number- 06062012@6

Bacterial and Fungal Contamination- Bacillus lentus, Bacillus circulans


Medication- Triamcinolone
40 mg/mL injectable ? 2 mL per vial

Lot Number- 08172012@60

Bacterial and Fungal Contamination- Aspergillus tubingensis, Penicillium sp.


Medication- Triamcinolone
40mg/mL injectable ? 10 mL per vial

Lot Number- 08242012@2

Bacterial and Fungal Contamination- Aspergillus fumigatus


Medication- Cardioplegia solution
265.5 mL per bag

Lot Number- 09242012@55

Bacterial and Fungal Contamination- Bacillus halmapalus/horikoshii, Brevibacillus choshinensis


(NOTE from CB: Edited for formatting.)
 
Re: FDA - Multistate outbreak of fungal meningitis and other infections - Bacterial and/or fungal contaminants identified in additional NECC products

Re: FDA - Multistate outbreak of fungal meningitis and other infections - Bacterial and/or fungal contaminants identified in additional NECC products

Update to the list of contaminants identified in NECC products. Newly identified contaminants are shown in red.




Laboratory Testing and Results

[12-12-2012] FDA and CDC have identified bacterial and/or fungal contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC. These include bacteria known as Bacillus, and fungal species including Aspergillus tubingensis, Aspergillus fumigatus, Cladosporium species,and Penicillium species. Although rare, some of the identified Bacillus species can be human pathogens. Some of the fungal organisms identified, particularly Aspergillus fumigatus, are known to cause disease in humans. It is not known how product contamination with these organisms could affect patients clinically. See CDC?s Advice for Clinicians.


CDC and FDA Laboratory-Confirmed Organisms from Product Samples

Laboratory-Confirmed Organisms from Product Samples Associated with
NECC Recalled Lots of Betamethasone, Cardioplegia, and Triamcinolone Solutions



Medication- Betamethasone
6 mg/mL injectable ?5 mL per vial

Lot Number- 08202012@141

Bacterial and Fungal Contamination- Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp., Bacillus niacini, Kocuria rosea,
Bacillus lentus


Medication- Betamethasone
6 mg/mL injectable ?5 mL per vial

Lot Number- 07032012@22

Bacterial and Fungal Contamination- Bacillus niabensis, Bacillus circulans


Medication- Betamethasone
12 mg/mL injectable ? 5 mL per vial

Lot Number- 07302012@52

Bacterial and Fungal Contamination- Bacillus lentus, Bacillus circulans, Bacillus niabensis, Paenibacillus barengoltzii/timonensis


Medication- Betamethasone
6mg/mL injectable ? 5 mL per vial

Lot Number- 08202012@44

Bacterial and Fungal Contamination- Bacillus lentus, Bacillus firmus, Bacillus pumilus


Medication- Betamethasone
6 mg/mL injectable ? 5 mL per vial

Lot Number- 08152012@84

Bacterial and Fungal Contamination- Penicillium sp., Cladosporium sp.


Medication- Triamcinolone*
40mg/mL injectable ? 1 mL per vial
*Other identification of bacteria are pending for this product

Lot Number- 06062012@6

Bacterial and Fungal Contamination- Bacillus lentus, Bacillus circulans, Bacillus niabensis, Bacillus nealsonii, Bacillus subtilis group, Bacillus firmus


Medication- Triamcinolone
40 mg/mL injectable ? 2 mL per vial

Lot Number- 08172012@60

Bacterial and Fungal Contamination- Aspergillus tubingensis, Penicillium sp.


Medication- Triamcinolone
40mg/mL injectable ? 10 mL per vial

Lot Number- 08242012@2

Bacterial and Fungal Contamination- Aspergillus fumigatus


Medication- Cardioplegia solution
265.5 mL per bag

Lot Number- 09242012@55

Bacterial and Fungal Contamination- Bacillus halmapalus/horikoshii, Brevibacillus choshinensis
 
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