LETTER
Burkholderia cepacia and Nebulized Albuterol
Lawrence Scharer, MD
15 January 1996 | Volume 124 Issue 2 | Page 274
TO THE EDITOR:
The recent report by Hamill and colleagues [1] on respiratory tract infection associated with nebulized bronchodilator therapy shows that modern equipment does not solve an old problem. Almost 30 years ago, the same observation was made at Bellevue Hospital in New York City [2] and helped to lead manufacturers to develop single-dose vials for this form of therapy.
In the Bellevue Hospital outbreak, which was caused by Klebsiella species and led to five deaths, a respiratory therapist was found to be an asymptomatic carrier of the same organism.
Perhaps it is time to abolish the use of multiple-dose medication vials for inhalation therapy. As my colleagues and I pointed out in the report of Bellevue outbreak [2], it is not surprising that contaminated aerosol solutions cause respiratory infections. The patients at Bellevue were not intubated but obviously remained at great risk for nosocomial infection. In Hamill and coworkers' experience, patients were mechanically ventilated, a factor that only increases the risk for infection. Although it does not completely remove the potential for hospital-acquired bacterial infection, single-dose aerosol therapy should be the standard.
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Author and Article Information
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St. Luke's Roosevelt Hospital Center; New York, NY 10019
1. Hamill RJ, Houston ED, Georghiou PR, Wright CE, Koza MA, Cadle RM, et al. An outbreak of Burkholderia (formerly (Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med. 1995; 122:762-6.
2. Mertz JJ, Scharer L, McClement JH. A hospital outbreak of Klebsiella pneumonia from inhalation therapy with contaminated aerosol solutions. Am Rev Respir Dis. 1967; 95:454-60.
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