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.
Hutchinson
G R
GR
Laboratory of Hospital Infection, Central Public Health Laboratory, London, UK.
Parker
S
S
Pryor
J A
JA
Duncan-Skingle
F
F
Hoffman
P N
PN
Hodson
M E
ME
Kaufmann
M E
ME
Pitt
T L
TL
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