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

  • Alison L. Galdys (a1) (a2) (a3), Jane W. Marsh (a1) (a2), Edgar Delgado (a4), A. William Pasculle (a2) (a5), Marissa Pacey (a2), Ashley M. Ayres (a3), Amy Metzger (a3), Lee H. Harrison (a1) (a2) (a3) and Carlene A. Muto (a1) (a2) (a3)...



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.


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.


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.


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.


Corresponding author

Author for correspondence: Alison L. Galdys, 420 Delaware Street SE, MMC 250, Minneapolis, MN 55455. E-mail:


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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.


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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1. Rutala, WA, Weber, DJ. Disinfection and sterilization in health care facilities: what clinicians need to know. Clin Infect Dis 2004;39:702709.
2. 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.
3. 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.
4. DiazGranados, CA, Jones, MY, Kongphet-Tran, T, et al. Outbreak of Pseudomonas aeruginosa infection associated with contamination of a flexible bronchoscope. Infect Control Hosp Epidemiol 2009;30:550555.
5. Weber, DJ, Rutala, WA. Lessons learned from outbreaks and pseudo-outbreaks associated with bronchoscopy. Infect Control Hosp Epidemiol 2012;33:230234.
6. Marsh, JW, Krauland, MG, Nelson, JS, et al. Genomic epidemiology of an endoscope-associated outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae . PLoS One 2015;10:e0144310.
7. Epstein, L, Hunter, JC, Arwady, MA, et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:14471455.
8. Wendorf, KA, Kay, M, Baliga, C, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol 2015:19.
9. Gastmeier, P, Vonberg, RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection 2014;42:1521.
10. Rutala, W, Weber, DJ, and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities. Centers for Diesase Control and Prevention website. Published 2008. Accessed October 5, 2018.
11. Vimont, S, Mnif, B, Fevre, C, Brisse, S. Comparison of PFGE and multilocus sequence typing for analysis of Klebsiella pneumoniae isolates. J Med Microbiol 2008;57:13081310.
12. Baym, M, Kryazhimskiy, S, Lieberman, TD, Chung, H, Desai, MM, Kishony, R. Inexpensive multiplexed library preparation for megabase-sized genomes. PLoS One 2015;10:e0128036.
13. Inouye, M, Dashnow, H, Raven, LA, et al. SRST2: rapid genomic surveillance for public health and hospital microbiology labs. Genome Med 2014;6:90.
14. Seemann, T. Prokka: rapid prokaryotic genome annotation. Bioinformatics 2014;30:20682069.
15. Stamatakis, A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics 2014;30:13121313.
16. Weinstein, RA, Stamm, WE. Pseudoepidemics in hospital. Lancet 1977;2:862864.
17. 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.
18. Cetre, JC, Nicolle, MC, Salord, H, et al. Outbreaks of contaminated broncho-alveolar lavage related to intrinsically defective bronchoscopes. J Hosp Infect 2005;61:3945.
19. Guy, M, Vanhems, P, Dananche, C, et al. Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated bronchoscope suction valves, Lyon, France, 2014. Euro Surveill 2016;21.
20. Srinivasan, A, Wolfenden, LL, Song, XY, et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. New Engl J Med 2003;348:221227.


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