Outbreak of nosocomial Flavobacterium meningosepticum respiratory infections associated with use of aerosolized polymyxin B.
Flavobacterium meningosepticum is an uncommon cause of adult nosocomial infection. On a medical/surgical intensive care unit we recently encountered an adult outbreak of respiratory colonization and infection caused by this organism, which was associated with the prophylactic use of aerosolized polymyxin B that had been used in an attempt to abort an outbreak of infection caused by highly resistant strains of Pseudomonas aeruginosa. Twenty isolates (95% from respiratory secretions) of F. meningosepticum from nine persons were identified during a 2 1/2-month period. No environmental source has been identified to date. Pneumonia developed in five patients, and two deaths associated with this organism occurred. All isolates were sensitive to ciprofloxacin; none were sensitive to other antibiotics tested, including third-generation cephalosporins, aminoglycosides, erythromycin, trimethoprim-sulfamethoxazole, antipseudomonal penicillins, aztreonam, and imipenem/cilastatin. Two patients with nosocomial pneumonia were successfully treated with oral ciprofloxacin. F. meningosepticum may emerge as an important pathogen if prophylactic use of polymyxin B becomes more widespread. Ciprofloxacin may become the agent of choice for treatment of this organism.
Brown
R B
RB
Infectious Disease Division, Baystate Medical Center, Springfield, MA 01199.
Phillips
D
D
Barker
M J
MJ
Pieczarka
R
R
Sands
M
M
Teres
D
D
D000280:Administration, Inhalation; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D004196:Disease Outbreaks; D005417:Flavobacterium; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007362:Intensive Care Units; D008404:Massachusetts; D008826:Microbial Sensitivity Tests; D011112:Polymyxin B / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011113:Polymyxins / Q000009:adverse effects*; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
D011113:Polymyxins; D002939:Ciprofloxacin; D011112:Polymyxin B