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Previous Volume 348:221-227 January 16, 2003 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Feigal, D. W. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Endoscopes, including bronchoscopes, are the medical devices most frequently associated with outbreaks of nosocomial infections. We investigated an outbreak of Pseudomonas aeruginosa infections after bronchoscopic procedures.

Methods Microbiologic results were reviewed to determine the rates of recovery of P. aeruginosa from bronchoalveolar-lavage specimens. Environmental samples from endoscopes and the endoscopy suite were cultured. Medical records were reviewed to identify infections in the 14 days after a bronchoscopy.

Results The rate of recovery of P. aeruginosa from bronchoalveolar-lavage specimens obtained with use of endoscopy-suite bronchoscopes increased from 10.4 percent at base line to 31.0 percent during the outbreak (relative risk, 2.97; 95 percent confidence interval, 2.28 to 3.90). Cultures of samples from three bronchoscopes grew P. aeruginosa, whereas cultures of samples from the environment, instrument-cleaning machines, and gastrointestinal endoscopes did not. The three bronchoscopes had been part of a nationwide recall. A total of 414 patients underwent bronchoscopy during the outbreak, and there were 48 respiratory tract and bloodstream infections among 39 of these patients (9.4 percent). In 32 infections (66.7 percent), P. aeruginosa was confirmed as a potentially causative organism. Exposure to a potentially contaminated bronchoscope may have had a role in the death of three patients. The rate of recovery of P. aeruginosa returned to base line after the instruments were removed from service.

Conclusions This large outbreak of P. aeruginosa infections related to bronchoscopy was apparently caused by a loose biopsy-port cap in the bronchoscopes. Instrument safety and surveillance methods for bronchoscopy must be improved, and better recall procedures are needed for medical devices.

Source Information

From the Department of Hospital Epidemiology and Infection Control (A.S., X.S., K.M., T.M.P.), the Divisions of Infectious Diseases (A.S., T.M.P.), Pulmonary and Critical Care Medicine (L.L.W., G.B.D., J.B.O., R.C.Y, E.F.H.), and Nephrology (P.J.S.), Department of Medicine, and the Departments of Anesthesiology and Critical Care Medicine (T.L.H.) and Pathology (T.L.R., W.M.), Johns Hopkins Medical Institutions, Baltimore; and the Pulmonary–Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md. (H.D.J.).

Address reprint requests to Dr. Srinivasan at the Office of Antibiotic Management, Johns Hopkins Hospital, 600 N. Wolfe St., Carnegie Bldg., Rm. 284, Baltimore, MD 21287-6284.

Full Text of this Article

Related Letters:

Outbreaks of Infection Associated with Bronchoscopes
Cetre J.-C., Salord H., Vanhems P., Srinivasan A., Perl T. M., Schaffner W., Jones T. F.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:2039-2040, May 15, 2003. Correspondence

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