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

Carlos A. DiazGranados , MD, Marolyn Y. Jones , RN, Thiphasone Kongphet‐Tran , BS, Nancy White , RN, Mark Shapiro , MS, Yun F. Wang , PhD, Susan M. Ray , MD and Henry M. Blumberg , MD
Infection Control and Hospital Epidemiology
Vol. 30, No. 6 (June 2009), pp. 550-555
DOI: 10.1086/597235
Stable URL: http://www.jstor.org/stable/10.1086/597235
Page Count: 6
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Outbreak of Pseudomonas aeruginosa Infection Associated With Contamination of a Flexible Bronchoscope
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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 B1 during the cluster period had a culture positive for P. aeruginosa, compared with 1 (2%) of 53 patients who were exposed to other bronchoscopes ( \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P< .001$ \end{document} ). 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 B1 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.

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