Pseudo-outbreak of Stenotrophomonas maltophilia due to contamination of bronchoscope

We noticed an abrupt increase in the isolation of Stenotrophomonas maltophilia from bronchoalveolar lavage (BAL) specimens collected at Chosun University Hospital. We performed surveillance cultures in order to identify the source of what appeared to be a pseudo-outbreak. To investigate a possible nosocomial outbreak of S. maltophilia, we performed culture of 11 environmental specimens obtained from a bronchoscopy room and two bronchoscopes. Pulsed-field gel electrophoresis (PFGE) was used to examine the genetic relatedness among the strains of S. maltophilia recovered from BAL specimens of 3 patients and 1 environmental sample, as well as 9 unrelated strains of S. maltophilia as a control. During a 7 day-period in March 2006, S. maltophilia was isolated from the BAL specimens of 7 of 13 (54%) patients, compared to only 5 of 188 (2.6%) patients during the 6-month period prior to that period. S. maltophilia was isolated from 1 of the 11 environmental samples, which was obtained from a fiberoptic bronchoscope suction channel. All 7 patient isolates and one environmental isolate exhibited similar antibiotic susceptibility patterns. PFGE analysis of the genomic DNA from epidemic strains demonstrated an identical banding pattern, whereas each of epidemiologically unrelated strains showed a unique electrophoretic pattern. Apparently one of the hospital bronchoscopes became contaminated with S. maltophilia during a bronchoscopic procedure. It is likely that subsequent specimen contamination occurred because the bronchoscope had been inadequately cleaned and disinfected. The pseudo-outbreak was controlled successfully by removing the source of infection.