PSEUDOMENINGITIS AGAIN - ASSOCIATION WITH CYTOCENTRIFUGE FUNNEL AND GRAM-STAIN REAGENT CONTAMINATION

Objective.-To report an ''epidemic'' of pseudomeningitis related to cy tocentrifuge funnel and Gram-stain reagent contamination, and our eval uation and responses. Design.-lnvestigation was stimulated by the reco gnition of Cram-stained, smear-positive, culture-negative cerebrospina l fluid (CSF) specimens. Cytofunnels, glass slides, Gram-staining reag ents, and an automated Cram-staining apparatus were subjected to repea ted staining and culture. Control stains and cultures using fetal bovi ne serum (simulated CSF) were performed for comparison. Setting.-The c linical microbiology laboratory of Parkland Memorial Hospital, a large acute-care teaching hospital. Specimens.-Cerebrospinal fluid specimen s were submitted to the clinical microbiology laboratory in the course of routine patient care. Main Outcome Measures.-Gram's stains and cul tures of test and control preparations. Results.-Most of the smear-pos itive, culture-negative, original CSF specimens contained Cram-positiv e bacilli or Cram-negative bacilli. Smears of cytofunnels revealed sim ilar organisms, and cultures revealed Bacillus species. Cytofunnels fr om several lots were culture-positive. Glass slides were not contamina ted. Of 25 CSF specimens stained during the initial week of investigat ion, 23 were negative by culture and two grew Cryptococcus neoformans (from acquired immunodeficiency syndrome patients). Control stains and cultures of simulated CSF were negative. Gram-stain reagents were fre quently smear-positive, and cultures repeatedly yielded Flavimonas ory zihabitans from the crystal violet well of an automated Gram-staining apparatus. These latter contaminants could not be eliminated consisten tly. Interventions.-No alternative sources of cytofunnels were found. The Gram-staining apparatus was cleaned and reagents changed frequentl y. Cytocentrifugation and use of automated Gram staining was discontin ued for CSF and other normally sterile fluids. The laboratory staff wa s repeatedly educated about the problem. Conclusions.-Contamination of cytocentrifuge funnels and an automated Gram-staining apparatus contr ibuted to are ''epidemic'' of pseudomeningitis. The problem was correc ted by education of the laboratory staff and by altered management of CSF and other sterile body fluid specimens.