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Cluster of Trichosporon mucoides in children associated with a faulty bronchoscope

SINGH, NALINI MD, MPH; BELEN, OZLEM MD; LÉGER, MARIE-MICHÈLE PAC, MPH; CAMPOS, JOSEPH M. PhD

Pediatric Infectious Disease Journal: July 2003 - Volume 22 - Issue 7 - pp 609-612
Original Studies

Background. Several outbreaks of Pseudomonas aeruginosa infection associated with a specific model of fiberoptic bronchoscope have been reported. In a 3-week period in September 2000, we noticed an increased number of Trichosporon mucoides isolates recovered from bronchoalveolar lavage (BAL) specimens collected at our hospital. We investigated the circumstances surrounding these isolates.

Methods. Outbreak investigation was conducted, and the medical records of the affected patients were reviewed retrospectively for evidence of positive cultures for T. mucoides from BAL specimens. Specimens collected during the investigation were inoculated onto fungal culture medium and yeasts were identified with API-20C (BioMèrieux-Vitek).

Results. During the 3-week period BAL specimens from six patients yielded growth of T. mucoides. These six high risk patients had emergency bronchoscopy performed as a workup for pneumonia and/or respiratory distress. A Model BF XP-40 bronchoscope (Olympus) had been used in all six patients. Cultures of the bronchoscope (external body and the lumen), bronchoscope disinfector, 2% glutaraldehyde disinfecting solution and water filters/supply were performed. Only fluid from the bronchoscope lumen yielded growth of T. mucoides. Air sample cultures of the bronchoscopy suites were negative. Medical records review disclosed that affected patients were not readmitted with infection with T. mucoides and had no adverse outcomes. The bronchoscope was removed from service and returned to the manufacturer.

Conclusion. Routine surveillance and aggressive investigation identified persistent T. mucoides contamination of one bronchoscope. The bronchoscope manufacturer later recalled the BF XP-40 model for corrective revision.

From the Departments of Pediatrics (NS, OB, JMC), Pathology (JMC), Microbiology/Tropical Medicine ((JMC) and Health Care Sciences (MML), George Washington University School of Medicine and Children’s National Medical Center, and the Department of Epidemiology, School of Public Health and Health Services, George Washington University (NS), Washington, DC.

Accepted for publication March 7, 2003.

Address for reprints: Nalini Singh, M.D., M.P.H., Department of Infectious Diseases, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010. Fax 202-884-3850; E-mail Nsingh@CNMC.ORG.

© 2003 Lippincott Williams & Wilkins, Inc.