Skip to main content Accessibility help

Outbreak of Pseudomonas aeruginosa Infection Associated With Contamination of a Flexible Bronchoscope

  • Carlos A. DiazGranados (a1) (a2), Marolyn Y. Jones (a2), Thiphasone Kongphet-Tran (a2), Nancy White (a2), Mark Shapiro (a3), Yun F. Wang (a4) (a3), Susan M. Ray (a1) (a2) and Henry M. Blumberg (a1) (a2)...



A cluster of patients with respiratory cultures positive for Pseudomonas aeruginosa with a unique antibiogram was observed during June and July 2007 at a 1,000-bed urban teaching hospital in Atlanta, Georgia. These P. aeruginosa isolates were recovered from bronchoscopically obtained specimens.


A cross-sectional study was performed to assess whether the cluster was associated with exposure to a particular bronchoscope (B1); cultures from specimens from the bronchoscopes and the environment were obtained, and the P. aeruginosa isolate type was determined using pulsed-field gel electrophoresis (PFGE). Records of patients exposed to B1 during the cluster period were reviewed.


Twelve patients with a culture positive for P. aeruginosa with the unique susceptibility pattern were identified in June-July 2007. No cases were documented from March 1 through May 31, 2007. Culture specimens obtained from B1 after high-level disinfection revealed P. aeruginosa, prompting removal of B1 from service on July 23, 2007. No cases occurred after that date. Eleven (55%) of 20 patients who were exposed to Bl during the cluster period had a culture positive for P. aeruginosa, compared with 1 (2%) of 53 patients who were exposed to other bronchoscopes (P < .001). PFGE patterns for P. aeruginosa isolates obtained from case patients and from B1 were identical. An engineering evaluation of B1 documented several internal damages. Two (10.5%) of 19 patients exposed to Bl during the cluster period may have developed P. aeruginosa infection following exposure to B1.


An outbreak or pseudo-outbreak of P. aeruginosa infection occurred in association with use of a damaged bronchoscope. Periodic engineering maintenance may be needed to prevent bronchoscope contamination that is resistant to high-level disinfection.


Corresponding author

49 Jesse Hill Jr. Dr., Atlanta, GA 30303 (


Hide All
1.Centers for Disease Control and Prevention. Bronchoscopy-related infections and pseudoinfections—New York, 1996 and 1998. MMWR Morb Mortal Wkly Rep 1999;48:557560.
2.Muscarella, LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying. Am J Gastroenterol 2006;101:21472154.
3.Rutala, WA, Weber, DJ. Reprocessing endoscopes: United States perspective. J Hosp Infect 2004;56(Suppl 2):S27S39.
4.Culver, DA, Gordon, SM, Mehta, AC. Infection control in the bronchoscopy suite: a review of outbreaks and guidelines for prevention. Am J Respir Crit Care Med 2003;167:10501056.
5.Srinivasan, A, Wolfenden, LL, Song, X, et al.An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med 2003;348:221227.
6.Kirschke, DL, Jones, TF, Craig, AS, et al.Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med 2003;348:214220.
7.Kolmos, HJ, Lerche, A, Kristoffersen, K, Rosdahl, VT. Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy. Scand J Infect Dis 1994;26:653657.
8.Sammartino, MT, Israel, RH, Magnussen, CR. Pseudomonas aeruginosa contamination of fiberoptic bronchoscopes. J Hosp Infect 1982;3:6571.
9.Blanc, DS, Parret, T, Janin, B, Raselli, P, Francioli, P. Nosocomial infections and pseudoinfections from contaminated bronchoscopes: two-year follow-up using molecular markers. Infect Control Hosp Epidemiol 1997;18:134136.
10.Corne, P, Godreuil, S, Jean-Pierre, H, et al.Unusual implication of biopsy forceps in outbreaks of Pseudomonas aeruginosa infections and pseudo-infections related to bronchoscopy. J Hosp Infect 2005;61:2026.
11.Grothues, D, Tummler, B. New approaches in genome analysis by pulsed -field gel electrophoresis: application to the analysis of Pseudomonas species. Mol Microbiol 1991;5:27632776.
12.Miller, PR, Johnson, JC 3rd, Karchmer, T, Hoth, JJ, Meredith, JW, Chang, MC. National Nosocomial Infection Surveillance system: from benchmark to bedside in trauma patients. J Trauma 2006;60:98103.
13.Pugin, J, Auckenthaler, R, Mili, N, lanssens, JP, Lew, PD, Suter, PM. Diagnosis of ventilator-associated pneumonia by bacteriologie analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:11211129.
14.Bone, RC, Sibbald, WJ, Sprung, CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992;101:14811483.
15.Alvarado, CJ, Reichelderfer, M; Association for Professionals in Infection Control. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 2000;28:138155.
16.Feigal, DJ, Hughes, JM. FDA and CDC public health advisory: infections from endoscopes inadequately reprocessed by an automated endoscope reprocessing system. 1999. Available at: Accessed May 21, 2008.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed