title: Outbreak of Pseudomonas aeruginosa infection associated with contamination of a flexible bronchoscope.
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 (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 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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. cdiazgr@emory.edu
authors.forename: Carlos A
authors.initials: CA
authors.lastname: DiazGranados
authors.forename: Marolyn Y
authors.initials: MY
authors.lastname: Jones
authors.forename: Thiphasone
authors.initials: T
authors.lastname: Kongphet-Tran
authors.forename: Nancy
authors.initials: N
authors.lastname: White
authors.forename: Mark
authors.initials: M
authors.lastname: Shapiro
authors.forename: Yun F
authors.initials: YF
authors.lastname: Wang
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ray
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D020680:Bronchoscopes / Q000382:microbiology*; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents