<i>Pseudomonas aeruginosa</i>and<i>Serratia marcescens</i>Contamination Associated with a Manufacturing Defect in Bronchoscopes

BackgroundPseudomonas aeruginosa infection is particularly associated with progressive and ultimately chronic recurrent respiratory infections in chronic obstructive pulmonary disease, bronchiectasis, chronic destroyed lung disease, and cystic fibrosis. Its treatment is also very complex because of drug resistance and recurrence.MethodsForty eight cultures from 18 patients with recurrent P. aeruginosa pneumonia from 1998 to 2002 were included in this study. Two or more pairs of sputum cultures were performed during 2 or more different periods of recurrences. The comparison of strains was made according to the phenotypic patterns of antibiotic resistance and chromosomal fingerprinting by pulsed field gel electrophoresis (PFGE) using the genomic DNA of P. aeruginosa from the sputum culture.ResultsPhenotypic patterns of antibiotic resistance of P. aeruginosa were not correlated with their prior antibiotic exposition. Fifteen of 18 patients (83.3%) had recurrent P. aeruginosa pneumonia caused by the strains with same PFGE pattern.ConclusionThese data suggest that the most of the recurrent P. aeruginosa infections in chronic lung disease occurred due to the relapse of prior infections. Further investigations should be performed for assessing the molecular mechanisms of the persistent colonization and for determining how to eradicate clonal persistence of P. aeruginosa.

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“…Genomic DNA for PFGE was prepared as previously reported12,13. Chromosomal DNA plugs were incubated with Xba I.…”

Section: Methodsmentioning

confidence: 99%

RecurrentPseudomonas aeruginosaInfection in Chronic Lung Diseases: Relapse or Reinfection?

et al. 2014

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“…Nelson indicated that in reprocessed flexible endoscopes, residual organic matter and biofilm is likely a result of "multiple cleaning and disinfection cycles over the life of the instrument [3]. " Furthermore, there is evidence of microbial survival in patient-used scopes [4,5] including: Mycobacterium tuberculosis survival of multiple patient-use/reprocessing cycles for 17 days; [6] Hepatitis C virus (HCV) infection of three successive patients within a few days in spite of reprocessing; [7] and Pseudomonas contaminated scopes and infection of 100 out of 410 patients, attributable to a scope design flaw [8,9]. Biofilm formation in flexible endoscopes has also been shown by SEM or suggested by various researchers, [3,2,10,11] with implications in facilitating infection transmission [11,12].…”

Section: Introductionmentioning

confidence: 99%

Modeling microbial survival in buildup biofilm for complex medical devices

Alfa

Howie

2009

BMC Infect Dis

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BackgroundFlexible endoscopes undergo repeated rounds of patient-use and reprocessing. Some evidence indicates that there is an accumulation or build-up of organic material that occurs over time in endoscope channels. This "buildup biofilm" (BBF) develops as a result of cyclical exposure to wet and dry phases during usage and reprocessing. This study investigated whether the BBF matrix represents a greater challenge to disinfectant efficacy and microbial eradication than traditional biofilm (TBF), which forms when a surface is constantly bathed in fluid.MethodsUsing the MBEC (Minimum Biofilm Eradication Concentration) system, a unique modelling approach was developed to evaluate microbial survival in BBF formed by repetitive cycles of drying, disinfectant exposure and re-exposure to the test organism. This model mimics the cumulative effect of the reprocessing protocol on flexible endoscopes. Glutaraldehyde (GLUT) and accelerated hydrogen peroxide (AHP) were evaluated to assess the killing of microbes in TBF and BBF.ResultsThe data showed that the combination of an organic matrix and aldehyde disinfection quickly produced a protective BBF that facilitated high levels of organism survival. In cross-linked BBF formed under high nutrient conditions the maximum colony forming units (CFU) reached ~6 Log10 CFU/peg. However, if an oxidizing agent was used for disinfection and if organic levels were kept low, organism survival did not occur. A key finding was that once established, the microbial load of BBF formed by GLUT exposure had a faster rate of accumulation than in TBF. The rate of biofilm survival post high-level disinfection (HLD) determined by the maximum Log10CFU/initial Log10CFU for E. faecalis and P. aeruginosa in BBF was 10 and 8.6 respectively; significantly different compared to a survival rate in TBF of ~2 for each organism. Data from indirect outgrowth testing demonstrated for the first time that there is organism survival in the matrix. Both TBF and BBF had surviving organisms when GLUT was used. For AHP survival was seen less frequently in BBF than in TBF.ConclusionThis BBF model demonstrated for the first time that survival of a wide range of microorganisms does occur in BBF, with significantly more rapid outgrowth compared to TBF. This is most pronounced when GLUT is used compared to AHP. The data supports the need for meticulous cleaning of reprocessed endoscopes since the presence of organic material and microorganisms prevents effective disinfection when GLUT and AHP are used. However, cross-linking agents like GLUT are not as effective when there is BBF. The data from the MBEC model of BBF suggest that for flexible endoscopes that are repeatedly used and reprocessed, the assurance of effective high-level disinfection may decrease if BBF develops within the channels.

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“…Bulaşma, kontamine aspirasyon valfleri, hasarlı biyopsi kanalları, kontamine topik anestezikler ve kontamine dezenfeksiyon makinelerinden kaynaklanmaktadır. Kontaminasyona bağlı olarak hem gerçek hem de yalancı salgınlar görülmektedir (7)(8)(9)(10).…”

Section: Introductionunclassified

Clinical Microbiology Laboratory in the Control of Healthcare-Associated Infections

Şenol¹,

Coskun²,

Gunduz³

et al. 2012

Klimik Dergisi

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Pseudomonas aeruginosaandSerratia marcescensContamination Associated with a Manufacturing Defect in Bronchoscopes

Abstract: We documented contamination of bronchoscopes with P. aeruginosa and S. marcescens and possible infection of patients at a community hospital as a result of the inadequate disinfection of bronchoscopes because of a manufacturing defect.

Cited by 120 publications

References 24 publications

RecurrentPseudomonas aeruginosaInfection in Chronic Lung Diseases: Relapse or Reinfection?

RecurrentPseudomonas aeruginosaInfection in Chronic Lung Diseases: Relapse or Reinfection?

Modeling microbial survival in buildup biofilm for complex medical devices

Clinical Microbiology Laboratory in the Control of Healthcare-Associated Infections

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