Contamination of hypertonic saline solutions in use by cystic fibrosis patients in Israel.
BACKGROUND
Treatment of cystic fibrosis (CF) patients with inhaled hypertonic saline (HS) solutions is safe, beneficial and reduces exacerbation rates. We studied contamination of solutions used by Israeli CF patients for prolonged periods.


METHODS
The study addressed whether daily opening of previously unopened solutions caused contamination, survival of 6 CF-associated bacteria in artificially inoculated solutions, in-use contamination of solutions and patterns of their use by patients.


RESULTS
Repeated opening did not contaminate solutions and survival of indicator bacteria was variable. Mycobacterium abscessus survived in 3% HS solution for 6 weeks and Burkholderia cenocepacia and Pseudomonas aeruginosa were longer. In 30/76 (39.5%) of used solutions 49 contaminants were found, none being common CF-associated pathogens.


CONCLUSIONS
Most CF-related bacteria survived to some degree in HS. Approximately 40% of solutions used by patients were contaminated by organisms of uncertain significance. Our findings highlight the potential risk posed by contamination of HS solutions and support recommendations to use sterile unit-dose formulations.
Department of Pharmacy, Schneider Children's Medical Center, 14 Kaplan St., PO Box 559, Petah Tikva 49202, Israel.
Orit
O
Peled
Cystic Fibrosis Foundation of Israel, 79 Krinitzy St., Ramat-Gan 52423, Israel; Graub Cystic Fibrosis Center, Pulmonary Unit, Schneider Children's Medical Center, 14 Kaplan St., PO Box 559, Petah Tikva 49202, Israel; Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel.
Vardit
V
Kalamaro
Department of Pediatrics and Cystic Fibrosis Center, Hadassah Hebrew University Hospital, PO Box 24035, Mount Scopus, Jerusalem 91240, Israel.
Eitan
E
Kerem
Department of Pediatrics and Cystic Fibrosis Center, Hadassah Hebrew University Hospital, PO Box 24035, Mount Scopus, Jerusalem 91240, Israel.
David
D
Shoseyov
Graub Cystic Fibrosis Center, Pulmonary Unit, Schneider Children's Medical Center, 14 Kaplan St., PO Box 559, Petah Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
Hannah
H
Blau
Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel.
Ori
O
Efrati
Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel. Electronic address: colinb@ekmd.huji.ac.il.
Colin
C
Block
D057508:Burkholderia cenocepacia / Q000302:isolation & purification; D003550:Cystic Fibrosis / Q000628:therapy*; D004340:Drug Contamination; D006801:Humans; D007557:Israel; D009161:Mycobacterium / Q000302:isolation & purification; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012462:Saline Solution, Hypertonic / Q000009:adverse effects*
D012462:Saline Solution, Hypertonic
Contamination; Cystic fibrosis; Hypertonic saline; Sterility; Unit dose