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Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae

Published online by Cambridge University Press:  19 November 2018

Alison L. Galdys ,
Jane W. Marsh ,
Edgar Delgado ,
A. William Pasculle ,
Marissa Pacey ,
Ashley M. Ayres ,
Amy Metzger ,
Lee H. Harrison  and
Carlene A. Muto
Alison L. Galdys*
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Jane W. Marsh
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania
Edgar Delgado
Affiliation:
University of Pittsburgh Medical Center Respiratory Care Department, Pittsburgh, Pennsylvania
A. William Pasculle
Affiliation:
University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of PittsburghDepartment of Pathology, Pittsburgh, Pennsylvania
Marissa Pacey
Affiliation:
University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania
Ashley M. Ayres
Affiliation:
University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Amy Metzger
Affiliation:
University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
Carlene A. Muto
Affiliation:
University of Pittsburgh Division of Infectious Diseases, Pittsburgh, Pennsylvania University of Pittsburgh Microbial Genomic Epidemiology Laboratory (MiGEL), Pittsburgh, Pennsylvania University of Pittsburgh Medical Center Presbyterian Infection Prevention and Control, Pittsburgh, Pennsylvania
*
Author for correspondence: Alison L. Galdys, 420 Delaware Street SE, MMC 250, Minneapolis, MN 55455. E-mail: galdys@umn.edu
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Abstract

Objective

Recovery of multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae from a cluster of patients in the medical intensive care unit (MICU) prompted an epidemiologic investigation for a common exposure.

Methods

Clinical and microbiologic data from MICU patients were retrospectively reviewed, MICU bronchoscopes underwent culturing and borescopy, and bronchoscope reprocessing procedures were reviewed. Bronchoscope and clinical MDR isolates epidemiologically linked to the cluster underwent molecular typing using pulsed-field gel electrophoresis (PFGE) followed by whole-genome sequencing.

Results

Of the 33 case patients, 23 (70%) were exposed to a common bronchoscope (B1). Both MDR P. aeruginosa and K. pneumonia were recovered from the bronchoscope’s lumen, and borescopy revealed a luminal defect. Molecular testing demonstrated genetic relatedness among case patient and B1 isolates, providing strong evidence for horizontal bacterial transmission. MDR organism (MDRO) recovery in 19 patients was ultimately linked to B1 exposure, and 10 of 19 patients were classified as belonging to an MDRO pseudo-outbreak.

Conclusions

Surveillance of bronchoscope-derived clinical culture data was important for early detection of this outbreak, and whole-genome sequencing was important for the confirmation of findings. Visualization of bronchoscope lumens to confirm integrity should be a critical component of device reprocessing.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 40 - 46
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: These data were presented in part (abstract 7176) at the Society for Healthcare Epidemiology of America Annual Meeting on May 14, 2015, in Orlando, Florida.

a

Authors of equal contribution.

Cite this article: Galdys AL, et al (2019). Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae. Infection Control & Hospital Epidemiology 2019, 40, 40–46. doi: 10.1017/ice.2018.263

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