Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis.
Inhalation of aerosols contaminated with gram-negative bacteria generated from home-use nebulizers used by cystic fibrosis (CF) patients may be a primary route for bacterial colonization of the lung. Burkholderia cepacia was isolated from 3 of [corrected] 35 home-use nebulizers, and Stenotrophomonas maltophilia was isolated from 4 of 35 home-use nebulizers. Sputum cultures for two patients whose nebulizers were contaminated with B. cepacia did not yield the organism. However, DNA macrorestriction analysis by pulsed-field gel electrophoresis confirmed that one of two strains of B. cepacia recovered from the nebulizer of a third patient was also present in the sputum of that patient. Although Pseudomonas aeruginosa was isolated from 34 patients, none of the nebulizers were positive for the organism. Sixty-nine percent of nebulizers were contaminated, and up to 16 different environmental colistin-resistant, gram-negative species were identified. The heaviest contamination was found beneath the chamber atomizer. A questionnaire survey showed that the majority of patients (28 of 34) were receiving nebulized colistin and/or gentamicin. Patients who followed recommended instructions for good nebulizer hygienic practice and paid particular attention to drying had minimal or no contamination of their nebulizers.
Laboratory of Hospital Infection, Central Public Health Laboratory, London, UK.
G R
GR
Hutchinson
S
S
Parker
J A
JA
Pryor
F
F
Duncan-Skingle
P N
PN
Hoffman
M E
ME
Hodson
M E
ME
Kaufmann
T L
TL
Pitt
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016956:Burkholderia cepacia / Q000302:isolation & purification*; D003091:Colistin / Q000494:pharmacology*; D003550:Cystic Fibrosis / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D009330:Nebulizers and Vaporizers
D000900:Anti-Bacterial Agents; D003091:Colistin