Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis

Denton, M.; Rajgopal, Ashwin K.; Mooney, Louise; Qureshi, Andleeb; Kerr, Kevin G.; Keer, V.; Pollard, Kathryn M.; Peckham, Daniel; Conway, S.

doi:10.1016/s0195-6701(03)00299-8

Cited by 56 publications

(31 citation statements)

References 10 publications

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“…A retrospective study of tobramycin in two placebo-controlled trials revealed that most S. maltophilia isolates occurred intermittently and were rarely persistent isolates (131); this occasional appearance of S. maltophilia in CF patients has been reported by several studies (76,168,338). As S. maltophilia has been recovered from nebulizers of CF patients (80,157), a small study tested the biofilm-forming abilities of environmental and clinical S. maltophilia isolates after exposure to tobramycin at a concentration (16,000 g/ml) found inside the nebulizers (234). All five biofilm-associated S. maltophilia isolates remained viable after exposure to tobramycin (234).…”

Section: New Treatment Strategiesmentioning

confidence: 91%

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Stenotrophomonas maltophilia: an Emerging Global Opportunistic Pathogen

2012

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SUMMARY Stenotrophomonas maltophilia is an emerging multidrug-resistant global opportunistic pathogen. The increasing incidence of nosocomial and community-acquired S. maltophilia infections is of particular concern for immunocompromised individuals, as this bacterial pathogen is associated with a significant fatality/case ratio. S. maltophilia is an environmental bacterium found in aqueous habitats, including plant rhizospheres, animals, foods, and water sources. Infections of S. maltophilia can occur in a range of organs and tissues; the organism is commonly found in respiratory tract infections. This review summarizes the current literature and presents S. maltophilia as an organism with various molecular mechanisms used for colonization and infection. S. maltophilia can be recovered from polymicrobial infections, most notably from the respiratory tract of cystic fibrosis patients, as a cocolonizer with Pseudomonas aeruginosa . Recent evidence of cell-cell communication between these pathogens has implications for the development of novel pharmacological therapies. Animal models of S. maltophilia infection have provided useful information about the type of host immune response induced by this opportunistic pathogen. Current and emerging treatments for patients infected with S. maltophilia are discussed.

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Section: New Treatment Strategiesmentioning

confidence: 91%

“…S. maltophilia has been identified on the surfaces of materials used in intravenous (i.v.) cannulae, prosthetic devices, dental unit waterlines, and nebulizers (80,157,188,200,228,250).…”

Section: S Maltophilia Was First Isolated In 1943 As Bacterium Bookementioning

confidence: 99%

Stenotrophomonas maltophilia: an Emerging Global Opportunistic Pathogen

2012

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“…319 Furthermore, S. maltophilia has been recovered from hospital sink drains, faucets, and potable water. 140,320 In general, genotyping analyses have not shown that isolates obtained from the hospital environmental are the same as those recovered from patients, 141,320 and the majority of non-CF patients infected with S. maltophilia had genetically distinct strains. 321 None of 24 S. maltophilia isolates recovered from water, taps, and sinks in patient rooms matched the strains recovered from individuals with CF.…”

Section: Iiid2 Healthcare Sources: Water Surfaces Equipment Airmentioning

confidence: 97%

“…1,7 Bacterial contamination of nebulizers used during hospitalizations has been demonstrated. 320 However, methods of caring for nebulizers in the hospital setting have been widely disparate [424][425][426] and have included changing nebulizers every 2-7 days; changing mouthpieces after each use; and rinsing them with sterile water, drying them, and then placing them in a plastic bag between uses. In the preparation of recommendations for this guideline, discrepancies in published guidelines were noted.…”

Section: Ive2 Healthcare Facilities: Respiratory Therapy Nebulizementioning

confidence: 99%

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Saiman

Siegel

LiPuma

et al. 2014

Infect. Control Hosp. Epidemiol.

344

382

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The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.

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“…While cognisant that S. maltophilia has been identified in hospital-use devices such as ventilators, humidifiers and nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis 5 , as well as hospital tap water and water used for bronchoscope flushing 6 , we are not aware of any previous reports of its isolation from portable home-and hospital-use devices. A detailed review of available guidelines for nebuliser care by O'Malley reported that, against Cystic Fibrosis Foundation guidelines, manufacturers sometimes advised use of tap water as a final step in rinsing respiratory equipment, when sterile water should be used 7 .…”

mentioning

confidence: 99%