CDC Probes for Answers in Knee Surgery Deaths

Lethal bacteria may have played a role, say experts

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By
HealthDay Reporter

WEDNESDAY, Nov. 21, 2001 (HealthDayNews) -- Health officials are calling on the nation's doctors to report any suspicious cases of joint surgery infection following the sudden and mysterious deaths of three Minnesota men who suffered catastrophic infections after elective knee surgery.

In a press conference today, the Centers for Disease Control and Prevention says it is investigating a "few" potential cases of complications after joint surgery since Oct. 1, but has yet to confirm any additional patients.

The men, ages 23, 60 and 78, died earlier this month within one to four days of their operations at two hospitals. Surgery on two of the men was done in a St. Cloud hospital northwest of Minneapolis; the other operation was done at a hospital 70 miles away. Lab tests turned up the lethal bacteria Clostridium sordellii in the blood of the 23-year-old victim.

However, although the two other men had similar symptoms, including a steep drop in blood pressure and severe abdominal pain, investigators haven't been able to determine what kind of germ, if any, killed them.

Each of the men was healthy before his operation -- which included knee replacement and cartilage repair -- yet each was dead within 24 hours of the onset of the symptoms. Two of the deaths occurred Nov. 11, and the third Nov. 16.

"At this point, we do not have anything that identifies a procedure or device" or other potential source for the apparent infections that killed the men, says Dr. Dan Jernigan, a CDC researcher involved in the investigation.

Clostridium sordellii, which is related to both botulism and tetanus, is extremely rare in people, although some cases have occurred in intravenous drug users. The bug is found in soil, and the men were reportedly farmers, but their occupation has not been implicated as a source for the infection, Jernigan says.

Dr. Julie Gerberding, acting deputy director of the CDC's National Center for Infectious Diseases, says the agency is engaged in a "full-court press" to track down the source of the deadly ailment.

The unofficial death rate after knee surgery is roughly 2 in 1,000, Jernigan says. In the wake of the three fatalities, Minnesota officials have asked local hospitals and surgery centers to temporarily suspend such procedures. Jernigan says the CDC has no plans to call for a similar moratorium in other states. "We are not considering that at all right now," he says.

Jernigan all but ruled out terrorism as a source of the infections, saying Clostridium sordellii is not on anyone's list of likely bioterror agents. "It may just be bad luck," he says.

Clostridium sordellii is treatable with antibiotics if caught early, officials say. It can also be prevented with prophylactic antibiotics.

What To Do

For more on clostridium infections, try the Oregon Health & Science University.

To learn more about knee surgery, try the University of Iowa's Virtual Hospital or About.com.

SOURCES: Teleconference with Dan Jernigan, M.D., M.P.H., researcher, National Center for Infectious Diseases; and Julie Gerberding, M.D., Ph.D., acting deputy director, National Center for Infectious Diseases; Nov. 22, 2001, CDC's Morbidity and Mortality Weekly Report

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