title: Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014.
abstract: In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to bronchoscope A1 and two to bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to bronchoscope channels, for routine detection of bacteria.
authors.affiliation: Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Guy
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
authors.forename: Cédric
authors.initials: C
authors.lastname: Dananché
authors.forename: Michel
authors.initials: M
authors.lastname: Perraud
authors.forename: Anne
authors.initials: A
authors.lastname: Regard
authors.forename: Monique
authors.initials: M
authors.lastname: Hulin
authors.forename: Olivier
authors.initials: O
authors.lastname: Dauwalder
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertrand
authors.forename: Jullien
authors.initials: J
authors.lastname: Crozon-Clauzel
authors.forename: Bernard
authors.initials: B
authors.lastname: Floccard
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Pierre
authors.initials: P
authors.lastname: Cassier
authors.forename: Thomas
authors.initials: T
authors.lastname: Bénet
mesh_terms: D000328:Adult; D000368:Aged; D020680:Bronchoscopes / Q000382:microbiology*; D060085:Coinfection / Q000453:epidemiology*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005602:France / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D058889:Molecular Typing; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification*
keywords: Pseudomonas aeruginosa; Stenotrophomonas maltophilia; bronchoscope; outbreak; pulmonary infection; suction valve contamination