Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T03:58:18.234Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Pseudomonas aeruginosa Infection Associated With Contamination of a Flexible Bronchoscope

Published online by Cambridge University Press:  02 January 2015

Carlos A. DiazGranados ,
Marolyn Y. Jones ,
Thiphasone Kongphet-Tran ,
Nancy White ,
Mark Shapiro ,
Yun F. Wang ,
Susan M. Ray  and
Henry M. Blumberg
Carlos A. DiazGranados*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia Emory University School of Medicine, and the Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
Marolyn Y. Jones
Affiliation:
Emory University School of Medicine, and the Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
Thiphasone Kongphet-Tran
Affiliation:
Emory University School of Medicine, and the Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
Nancy White
Affiliation:
Emory University School of Medicine, and the Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
Mark Shapiro
Affiliation:
Clinical Microbiology Laboratory, Grady Memorial Hospital, Atlanta, Georgia
Yun F. Wang
Affiliation:
Department of Pathology and Laboratory Medicine, Grady Memorial Hospital, Atlanta, Georgia Clinical Microbiology Laboratory, Grady Memorial Hospital, Atlanta, Georgia
Susan M. Ray
Affiliation:
Division of Infectious Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia Emory University School of Medicine, and the Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
Henry M. Blumberg
Affiliation:
Division of Infectious Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia Emory University School of Medicine, and the Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
*
49 Jesse Hill Jr. Dr., Atlanta, GA 30303 (cdiazgr@emory.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

A cluster of patients with respiratory cultures positive for Pseudomonas aeruginosa with a unique antibiogram was observed during June and July 2007 at a 1,000-bed urban teaching hospital in Atlanta, Georgia. These P. aeruginosa isolates were recovered from bronchoscopically obtained specimens.

Methods.

A cross-sectional study was performed to assess whether the cluster was associated with exposure to a particular bronchoscope (B1); cultures from specimens from the bronchoscopes and the environment were obtained, and the P. aeruginosa isolate type was determined using pulsed-field gel electrophoresis (PFGE). Records of patients exposed to B1 during the cluster period were reviewed.

Results.

Twelve patients with a culture positive for P. aeruginosa with the unique susceptibility pattern were identified in June-July 2007. No cases were documented from March 1 through May 31, 2007. Culture specimens obtained from B1 after high-level disinfection revealed P. aeruginosa, prompting removal of B1 from service on July 23, 2007. No cases occurred after that date. Eleven (55%) of 20 patients who were exposed to Bl during the cluster period had a culture positive for P. aeruginosa, compared with 1 (2%) of 53 patients who were exposed to other bronchoscopes (P < .001). PFGE patterns for P. aeruginosa isolates obtained from case patients and from B1 were identical. An engineering evaluation of B1 documented several internal damages. Two (10.5%) of 19 patients exposed to Bl during the cluster period may have developed P. aeruginosa infection following exposure to B1.

Conclusions.

An outbreak or pseudo-outbreak of P. aeruginosa infection occurred in association with use of a damaged bronchoscope. Periodic engineering maintenance may be needed to prevent bronchoscope contamination that is resistant to high-level disinfection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 6 , June 2009 , pp. 550 - 555
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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.)

References

1.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections—New York, 1996 and 1998. MMWR Morb Mortal Wkly Rep 1999;48:557–560.Google Scholar
2.Muscarella, LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying. Am J Gastroenterol 2006;101:2147–2154.Google Scholar
3.Rutala, WA, Weber, DJ. Reprocessing endoscopes: United States perspective. J Hosp Infect 2004;56(Suppl 2):S27–S39.Google Scholar
4.Culver, DA, Gordon, SM, Mehta, AC. Infection control in the bronchoscopy suite: a review of outbreaks and guidelines for prevention. Am J Respir Crit Care Med 2003;167:1050–1056.Google Scholar
5.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
6.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.CrossRefGoogle ScholarPubMed
7.Kolmos, HJ, Lerche, A, Kristoffersen, K, Rosdahl, VT. Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy. Scand J Infect Dis 1994;26:653–657.Google Scholar
8.Sammartino, MT, Israel, RH, Magnussen, CR. Pseudomonas aeruginosa contamination of fiberoptic bronchoscopes. J Hosp Infect 1982;3:65–71.Google Scholar
9.Blanc, DS, Parret, T, Janin, B, Raselli, P, Francioli, P. Nosocomial infections and pseudoinfections from contaminated bronchoscopes: two-year follow-up using molecular markers. Infect Control Hosp Epidemiol 1997;18:134–136.Google Scholar
10.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.CrossRefGoogle ScholarPubMed
11.Grothues, D, Tummler, B. New approaches in genome analysis by pulsed -field gel electrophoresis: application to the analysis of Pseudomonas species. Mol Microbiol 1991;5:2763–2776.Google Scholar
12.Miller, PR, Johnson, JC 3rd, Karchmer, T, Hoth, JJ, Meredith, JW, Chang, MC. National Nosocomial Infection Surveillance system: from benchmark to bedside in trauma patients. J Trauma 2006;60:98–103.Google Scholar
13.Pugin, J, Auckenthaler, R, Mili, N, lanssens, JP, Lew, PD, Suter, PM. Diagnosis of ventilator-associated pneumonia by bacteriologie analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:1121–1129.Google Scholar
14.Bone, RC, Sibbald, WJ, Sprung, CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992;101:1481–1483.Google Scholar
15.Alvarado, CJ, Reichelderfer, M; Association for Professionals in Infection Control. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138–155.Google Scholar
16.Feigal, DJ, Hughes, JM. FDA and CDC public health advisory: infections from endoscopes inadequately reprocessed by an automated endoscope reprocessing system. 1999. Available at: http://www.fda.gov/cdrh/safety/endoreprocess.html. Accessed May 21, 2008.Google Scholar