Emerg Infect DisEIDEmerging Infectious Diseases1080-60401080-6059Centers for Disease Control and Prevention266067507-061610.3201/eid1501.070616ResearchCME ACTIVITY: Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl120091511212Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at http://www.medscape.com/cme/eid; (4) view/print certificate.

Learning Objectives

Upon completion of this activity, participants will be able to:

Describe the types of bacterial contamination associated with different compounding pharmacy medications.

Describe the features of Sphingomonas paucimobilis bacteria.

Identify the types of exposure associated with transmission of S. paucimobilis infection with contaminated fentanyl.

Describe a strategy that would limit the occurrence of compounding pharmacy product contamination.

Editor

Lynne Stockton, Copy Editor, Emerging Infectious Diseases. Disclosure: Lynne Stockton has disclosed no relevant financial relationships.

CME AUTHOR

Désirée Lie, MD, MSEd, Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California. Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

AUTHORS

Disclosures: Lisa L. Maragakis, MD, MPH; Romanee Chaiwarith, MD, MHS; Arjun Srinivasan, MD; Francesca J. Torriani, MD, FIDSA; Edina Avdic, PharmD; Andrew Lee, BS, MPH; and Tracy R. Ross, BS, have disclosed no relevant financial relationships. Karen C. Carroll, MD, has disclosed that she has received grants for clinical support from BD GeneOhm, Prodesse, MicroPhage, and has served as an advisor or consultant to Boehringer Ingelheim and OpGen. Trish M. Perl, MD, MSc, has disclosed that she has received grants for clinical research from 3M and Sage and has served as an advisor or consultant to 3M, TheraDoc, and GlaxoSmithKline. Dr. Perl has also disclosed that she has served on the data monitoring board for Cadence.

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions and earn continuing medical education (CME) credit, please go to http://www.medscape.com/cme/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.com. If you are not registered on Medscape.com, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit is acceptable as evidence of participation in CME activities. If you are not licensed in the US and want to obtain an AMA PRA CME credit, please complete the questions online, print the certificate and present it to your national medical association.

Article Title: <italic>Sphingomonas paucimobilis</italic> Bloodstream Infections Associated with Contaminated Intravenous Fentanyl
CME Questions

Which of the following organisms is most likely to have been reported as a contaminant associated with betamethasone injection?

A. Sphingomonas paucimobilis

B. Serratia marcescens

C. Pseudomonas putida

D. Exophiala spp.

Which of the following is least likely to be an accurate description of S. paucimobilis?

A. Gram-positive

B. Glucose-nonfermenting

C. Yellow-pigmented

D. Found in soil and water

In this case series, which of the following was investigated as a source of exposure to fentanyl that resulted in S. paucimobilis bacteremia infection in patients?

A. Intravenous infusions

B. Contrast agents

C. Medications

D. All of the above

Which of the following strategies was recommended by the study authors to reduce the incidence of bacterial contamination by compounding pharmacies?

A. Inspect source of drugs before preparation

B. End-product sterility testing

C. Elimination of compounding pharmacies

D. None of the above

Activity Evaluation
1. The activity supported the learning objectives.
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2. The material was organized clearly for learning to occur.
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3. The content learned from this activity will impact my practice.
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4. The activity was presented objectively and free of commercial bias.
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