HOME-USE NEBULIZERS - A POTENTIAL PRIMARY SOURCE OF BURKHOLDERIA-CEPACIA AND OTHER COLISTIN-RESISTANT, GRAM-NEGATIVE BACTERIA IN PATIENTS WITH CYSTIC-FIBROSIS

Inhalation of aerosols contaminated with gram-negative bacteria genera ted from home-use nebulizers used by cystic fibrosis (CF) patients may be a primary route for bacterial colonization of the lung. Burkholder ia cepacia was isolated from 3 to 35 home-use nebulizers, and Stenotro phomonas maltophilia was isolated from 4 of 35 home-use nebulizers. Sp utum cultures for two patients whose nebulizers,t ere contaminated wit h B. cepacia did not yield the organism. However, DNA macrorestriction analysis by pulsed-field gel electrophoresis confirmed that one of tw o strains of B. cepacia recovered from the nebulizer of a third patien t was also present in the sputum of that patient. Although Pseudomonas aeruginosa was isolated from 34 patients, none of the nebulizers were positive for the organism, Sixty-nine percent of nebulizers were cont aminated, and up to 16 different environmental colistin-resistant, gra m-negative species were identified. The heaviest contamination was fou nd beneath the chamber atomizer. A questionnaire survey showed that th e majority of patients (28 of 34) were receiving nebulized colistin an d/or gentamicin. Patients who followed recommended instructions for go od nebulizer hygienic practice and paid particular attention to drying had minimal or no contamination of their nebulizers.