Hostname: page-component-745bb68f8f-b6zl4 Total loading time: 0 Render date: 2025-01-27T04:22:27.027Z Has data issue: false hasContentIssue false
  • English
  • Français

Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae

Published online by Cambridge University Press:  19 November 2018

Alison L. Galdys ,
Jane W. Marsh ,
Edgar Delgado ,
A. William Pasculle ,
Marissa Pacey ,
Ashley M. Ayres ,
Amy Metzger ,
Lee H. Harrison  and
Carlene A. Muto
Alison L. Galdys*
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Jane W. Marsh
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania
Edgar Delgado
Affiliation:
University of Pittsburgh Medical Center Respiratory Care Department, Pittsburgh, Pennsylvania
A. William Pasculle
Affiliation:
University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of PittsburghDepartment of Pathology, Pittsburgh, Pennsylvania
Marissa Pacey
Affiliation:
University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania
Ashley M. Ayres
Affiliation:
University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Amy Metzger
Affiliation:
University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Carlene A. Muto
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
*
Author for correspondence: Alison L. Galdys, 420 Delaware Street SE, MMC 250, Minneapolis, MN 55455. E-mail: galdys@umn.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Recovery of multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae from a cluster of patients in the medical intensive care unit (MICU) prompted an epidemiologic investigation for a common exposure.

Methods

Clinical and microbiologic data from MICU patients were retrospectively reviewed, MICU bronchoscopes underwent culturing and borescopy, and bronchoscope reprocessing procedures were reviewed. Bronchoscope and clinical MDR isolates epidemiologically linked to the cluster underwent molecular typing using pulsed-field gel electrophoresis (PFGE) followed by whole-genome sequencing.

Results

Of the 33 case patients, 23 (70%) were exposed to a common bronchoscope (B1). Both MDR P. aeruginosa and K. pneumonia were recovered from the bronchoscope’s lumen, and borescopy revealed a luminal defect. Molecular testing demonstrated genetic relatedness among case patient and B1 isolates, providing strong evidence for horizontal bacterial transmission. MDR organism (MDRO) recovery in 19 patients was ultimately linked to B1 exposure, and 10 of 19 patients were classified as belonging to an MDRO pseudo-outbreak.

Conclusions

Surveillance of bronchoscope-derived clinical culture data was important for early detection of this outbreak, and whole-genome sequencing was important for the confirmation of findings. Visualization of bronchoscope lumens to confirm integrity should be a critical component of device reprocessing.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 40 - 46
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: These data were presented in part (abstract 7176) at the Society for Healthcare Epidemiology of America Annual Meeting on May 14, 2015, in Orlando, Florida.

a

Authors of equal contribution.

Cite this article: Galdys AL, et al (2019). Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae. Infection Control & Hospital Epidemiology 2019, 40, 40–46. doi: 10.1017/ice.2018.263

References

1. Rutala, WA, Weber, DJ. Disinfection and sterilization in health care facilities: what clinicians need to know. Clin Infect Dis 2004;39:702–709.Google Scholar
2. Srinivasan, A, Wolfenden, LL, Song, X, et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med 2003;348:221–227.Google Scholar
3. Corne, P, Godreuil, S, Jean-Pierre, H, et al. Unusual implication of biopsy forceps in outbreaks of Pseudomonas aeruginosa infections and pseudo-infections related to bronchoscopy. J Hosp Infect 2005;61:20–26.Google Scholar
4. DiazGranados, CA, Jones, MY, Kongphet-Tran, T, et al. Outbreak of Pseudomonas aeruginosa infection associated with contamination of a flexible bronchoscope. Infect Control Hosp Epidemiol 2009;30:550–555.Google Scholar
5. Weber, DJ, Rutala, WA. Lessons learned from outbreaks and pseudo-outbreaks associated with bronchoscopy. Infect Control Hosp Epidemiol 2012;33:230–234.Google Scholar
6. Marsh, JW, Krauland, MG, Nelson, JS, et al. Genomic epidemiology of an endoscope-associated outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae . PLoS One 2015;10:e0144310.Google Scholar
7. Epstein, L, Hunter, JC, Arwady, MA, et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:1447–1455.Google Scholar
8. Wendorf, KA, Kay, M, Baliga, C, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol 2015:1–9.Google Scholar
9. Gastmeier, P, Vonberg, RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection 2014;42:15–21.Google Scholar
10. Rutala, W, Weber, DJ, and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities. Centers for Diesase Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf. Published 2008. Accessed October 5, 2018.Google Scholar
11. Vimont, S, Mnif, B, Fevre, C, Brisse, S. Comparison of PFGE and multilocus sequence typing for analysis of Klebsiella pneumoniae isolates. J Med Microbiol 2008;57:1308–1310.Google Scholar
12. Baym, M, Kryazhimskiy, S, Lieberman, TD, Chung, H, Desai, MM, Kishony, R. Inexpensive multiplexed library preparation for megabase-sized genomes. PLoS One 2015;10:e0128036.Google Scholar
13. Inouye, M, Dashnow, H, Raven, LA, et al. SRST2: rapid genomic surveillance for public health and hospital microbiology labs. Genome Med 2014;6:90.Google Scholar
14. Seemann, T. Prokka: rapid prokaryotic genome annotation. Bioinformatics 2014;30:2068–2069.Google Scholar
15. Stamatakis, A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics 2014;30:1312–1313.Google Scholar
16. Weinstein, RA, Stamm, WE. Pseudoepidemics in hospital. Lancet 1977;2:862–864.Google Scholar
17. Kirschke, DL, Jones, TF, Craig, AS, et al. Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med 2003;348:214–220.Google Scholar
18. Cetre, JC, Nicolle, MC, Salord, H, et al. Outbreaks of contaminated broncho-alveolar lavage related to intrinsically defective bronchoscopes. J Hosp Infect 2005;61:39–45.Google Scholar
19. Guy, M, Vanhems, P, Dananche, C, et al. Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014. Euro Surveill 2016;21.Google Scholar
20. Srinivasan, A, Wolfenden, LL, Song, XY, et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. New Engl J Med 2003;348:221–227.Google Scholar