An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes

Arjun Srinivasan, Linda L. Wolfenden, Xiaoyan Song, Karen Mackie, Theresa L. Hartsell, Heather D. Jones, Gregory B. Diette, Jonathan B. Orens, Rex C. Yung, Tracy L. Ross, William Merz, Paul J. Scheel, Edward F. Haponik, Trish M. Perl

Research output: Contribution to journalArticle

150 Citations (Scopus)

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 ofP. 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, where-as 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 ofP. 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.

Original languageEnglish (US)
Pages (from-to)221-227
Number of pages7
JournalNew England Journal of Medicine
Volume348
Issue number3
DOIs
StatePublished - Jan 16 2003

Fingerprint

Bronchoscopes
Pseudomonas Infections
Pseudomonas aeruginosa
Disease Outbreaks
Bronchoscopy
Endoscopes
Bronchoalveolar Lavage
Endoscopy
Gastrointestinal Endoscopes
Equipment and Supplies
Cross Infection
Infection
Respiratory Tract Infections
Medical Records
Confidence Intervals
Biopsy
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Srinivasan, A., Wolfenden, L. L., Song, X., Mackie, K., Hartsell, T. L., Jones, H. D., ... Perl, T. M. (2003). An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. New England Journal of Medicine, 348(3), 221-227. https://doi.org/10.1056/NEJMoa021808

An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. / Srinivasan, Arjun; Wolfenden, Linda L.; Song, Xiaoyan; Mackie, Karen; Hartsell, Theresa L.; Jones, Heather D.; Diette, Gregory B.; Orens, Jonathan B.; Yung, Rex C.; Ross, Tracy L.; Merz, William; Scheel, Paul J.; Haponik, Edward F.; Perl, Trish M.

In: New England Journal of Medicine, Vol. 348, No. 3, 16.01.2003, p. 221-227.

Research output: Contribution to journalArticle

Srinivasan, A, Wolfenden, LL, Song, X, Mackie, K, Hartsell, TL, Jones, HD, Diette, GB, Orens, JB, Yung, RC, Ross, TL, Merz, W, Scheel, PJ, Haponik, EF & Perl, TM 2003, 'An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes', New England Journal of Medicine, vol. 348, no. 3, pp. 221-227. https://doi.org/10.1056/NEJMoa021808
Srinivasan A, Wolfenden LL, Song X, Mackie K, Hartsell TL, Jones HD et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. New England Journal of Medicine. 2003 Jan 16;348(3):221-227. https://doi.org/10.1056/NEJMoa021808
Srinivasan, Arjun ; Wolfenden, Linda L. ; Song, Xiaoyan ; Mackie, Karen ; Hartsell, Theresa L. ; Jones, Heather D. ; Diette, Gregory B. ; Orens, Jonathan B. ; Yung, Rex C. ; Ross, Tracy L. ; Merz, William ; Scheel, Paul J. ; Haponik, Edward F. ; Perl, Trish M. / An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. In: New England Journal of Medicine. 2003 ; Vol. 348, No. 3. pp. 221-227.
@article{6678a1ce208b4156be50e46287d02925,
title = "An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes",
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 ofP. 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, where-as 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 ofP. 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.",
author = "Arjun Srinivasan and Wolfenden, {Linda L.} and Xiaoyan Song and Karen Mackie and Hartsell, {Theresa L.} and Jones, {Heather D.} and Diette, {Gregory B.} and Orens, {Jonathan B.} and Yung, {Rex C.} and Ross, {Tracy L.} and William Merz and Scheel, {Paul J.} and Haponik, {Edward F.} and Perl, {Trish M.}",
year = "2003",
month = "1",
day = "16",
doi = "10.1056/NEJMoa021808",
language = "English (US)",
volume = "348",
pages = "221--227",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "3",

}

TY - JOUR

T1 - An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes

AU - Srinivasan, Arjun

AU - Wolfenden, Linda L.

AU - Song, Xiaoyan

AU - Mackie, Karen

AU - Hartsell, Theresa L.

AU - Jones, Heather D.

AU - Diette, Gregory B.

AU - Orens, Jonathan B.

AU - Yung, Rex C.

AU - Ross, Tracy L.

AU - Merz, William

AU - Scheel, Paul J.

AU - Haponik, Edward F.

AU - Perl, Trish M.

PY - 2003/1/16

Y1 - 2003/1/16

N2 - 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 ofP. 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, where-as 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 ofP. 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.

AB - 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 ofP. 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, where-as 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 ofP. 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.

UR - http://www.scopus.com/inward/record.url?scp=0037448354&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037448354&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa021808

DO - 10.1056/NEJMoa021808

M3 - Article

C2 - 12529462

AN - SCOPUS:0037448354

VL - 348

SP - 221

EP - 227

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 3

ER -