Officials look for link in surgery deaths

Bacterial infection found in one patient

WASHINGTON (CNN) -- U.S. health officials still are not sure what caused three men in Minnesota to die after knee surgery, but are asking doctors nationwide to report any similar cases connected with knee or large joint surgery since October 1.

Clostridium bacteria was found in one patient's blood. Dr. Harry Hull, the Minnesota state epidemiologist, said investigators are looking at whether that caused the death and whether it was acquired in the hospital.

Preliminary results of a Minnesota Health Department study showed no factors that would transmit the bacteria.

One patient was embalmed before samples could be taken, and test results on the third patient are pending. Hull said the tests should show a positive reading in the next couple of days if the bacteria was a factor.

Clostridium is a genus of anaerobic bacteria commonly found in the soil and capable of surviving in a closed wound. Some species produce potent toxins; the best known are those that cause botulism and tetanus.

Although hospital-acquired infections are not rare, Dr. Dan Jernigan, an epidemiologist with the Centers for Disease Control and Prevention in Atlanta, said an infection of Clostridium bacteria would be considered rare.

Doctors looking through labs in Minnesota to see whether any illness has ever been attributed to Clostridium have yet to find a single case, Hull said.

Two hospitals performed the three surgeries, a spokesman for the Minnesota Health Department said. The two patients who were at the same hospital had their surgeries in different operating rooms with different surgical teams.

All of the men were healthy before their surgeries and became sick one to four days after going home.

Hull said death occurred less than a day after the onset of symptoms, which included severe abdominal pain and a sudden drop in blood pressure.

The hospitals are in a farming community. One victim was a farmer, 60, one a retired farmer, 78, and the third was a 23-year-old student, Hull said. Two died November 11 and one died November 16.

Two of the men had knee replacements; the other had a cartilage graft.

Hull and the CDC said they are investigating other cases to see if there are any links. Hull said they are looking at fewer than 10 such cases in Minnesota; the CDC would not say how many it is investigating.

Finding a link between only three cases is extremely challenging, Hull said, and that is why doctors are expanding the search for similar cases nationwide.

The state health department has suspended all elective knee surgeries in Minnesota until at least this Sunday.

The normal mortality rate for knee surgery is 2 per 1,000, doctors said.

Reports of people who died or required intensive care following knee surgery after October 1 are to be made to state health departments.