Factors associated with Pseudomonas pickettii intrinsic contamination of commercial respiratory therapy solutions marketed as sterile

Abstract

Laboratory investigations were conducted to study the growth dynamics of Pseudomonas pickettii in commercial 0.9% sodium chloride solution under various environmental conditions and to determine the retention of these organisms after challenge through a 0.2-,um cartridge filter system. Low numbers of P. pickettii (1 to 10 CFU/ml of test solution) inoculated into commercial vials containing 5 ml of 0.9% sodium chloride solution and 500-ml volumes of 0.9% sodium chloride solution were shown to proliferate over a 168-h incubation period. These organisms demonstrated growth over a wide range of temperatures (15 to 42°C) in this salt solution, and survival studies at 50, 55, and 60°C indicated that this strain was not unusually resistant to heat (with the times required at a given temperature to reduce the surviving microbial population 10-fold [D-values] being 26.0, 1.9, and 0.7 min, respectively). A challenge test demonstrated that P. pickettii organisms were not completely retained by a 0.2-,um cartridge filter. The number of organisms detected increased from 1 CFU/liter of effluent at 1 to 2 min to a maximum of 176 CFU/liter at 4 to 5 min. Our results indicate that P. pickettii can penetrate a 0.2-,um filtration system and that the passage of organisms and subsequent microbial growth in the filter effluent probably are the mechanisms by which these organisms were recovered from "sterile" commercial 0.9% sodium chloride solution.

Ralstonia pickettii—innocent bystander or a potential threat?

“…Thus, while being low in total numbers, infections with R. pickettii may affect immunocompromised patients or patients suffering from CF [2,11,12]. Contaminated medical solutions are one of the most important sources of R. pickettii [4,5,[13][14][15]. PCR-based identification and other new systems may be able to improve the efficiency of diagnosis [16][17][18].…”

Laboratory replication of filtration procedures associated with Serratia marcescens bloodstream infections in patients receiving compounded amino acid solutions

“…Similarly, an investigation of 0.2μm filter challenges with R. pickettii cultured for a week in 0.9% sodium chloride solution documented the greatest filter penetration in the earliest collected filtrate fractions. 30 Our detection of breakthrough required a minimum filtrate volume of 100 mL. On the basis of our testing, it is likely that the volumes of compounded amino acid solution submitted by pharmacy A 1 to laboratories for sterility testing were insufficient for the detection of small numbers of heterogeneously distributed organisms, whereas the 10% volume recommended in USP chapter 71 5 increases the likelihood of detecting bacterial contamination and more closely approximates the volumes examined in our study.…”

“…29 Sundaram et al 23 demonstrated that bacteria up to 0.68 μm in width can penetrate filters with a nominal 0.2μm pore size and that the width of the bacteria, instead of the length, determined their ability to penetrate filter pores. Other clinically relevant organisms, including Stenotrophomonas maltophilia , Acinetobacter baumannii , Pseudomonas putida, 23 B. contaminans, 11 and R. pickettii , 30 can also penetrate 0.2-μm filters.…”

Native Valve Endocarditis due toRalstonia pickettii: A Case Report and Literature Review

“…Prior to 2006 Ryan et al provide an excellent comprehensive review [ 1 ]. The presumptive ability of Ralstonia to persist in these sterile solutions is thought to be associated with its ability to survive within a wide range of temperatures (15°C–42°C) and pass through both 0.2 and 0.45 μ m filters, which are used to filter-sterilize medical solutions [ 18 ]. In a review of the literature there have been 55 cases of Ralstonia species infections, ranging from bacteremia to meningitis.…”