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Pseudomonas pickettii Colonization Associated with a Contaminated Respiratory Therapy Solution -- Illinois

From July 30 to August 1, 1983, five infants in the special-care nursery of a hospital in Chicago, Illinois, became colonized with Pseudomonas pickettii, which had not been reported by the hospital's microbiology department in any culture during the previous 15 months. Colonization was detected because all endotracheally intubated infants had had routine cultures of endotracheal aspirates performed three times a week. At this time, CDC has not confirmed any patient disease due to P. pickettii in hospitals receiving contaminated Modu-Dose solutions.

Each of the colonized infants had a history of endotracheal intubation before the positive culture, and in all five cases, the isolation was made from an endotracheal aspirate. All infants also had undergone endotracheal suctioning, which was routinely performed by first instilling 0.25 ml 0.9% NaCl solution, distributed commercially as sterile 5-ml unit-dose vials (Modu-Dose*, Becton Dickinson Respiratory Systems, Lincoln Park, New Jersey), into the endotracheal tube to assist in loosening secretions. The remainder of the solution in the vial was discarded after use on each patient.

On August 3, 1983, the hospital became aware of the manufacturer's recall of Modu-Dose products (because of intrinsic bacterial contamination), and the product was removed from all patient-care areas. Epidemiologic evaluation revealed that Modu-Dose was commonly used by the respiratory therapy department, with the heaviest use in the special-care nursery. Adult patients also received this product as a diluent for bronchodilator solutions in hand-held jet nebulizers and intermittent, positive-pressure breathing circuits. Surveillance cultures of adults were carried out, but no colonization was found. However, only in the special-care nursery was the product instilled directly into the lower respiratory tract. No further colonization of infants has occurred since use of the product was discontinued on August 3.

Samples of Modu-Dose from different lots in use thoughout the hospital were cultured by the hospital's microbiology department. Vials from one lot of 0.9% NaCl (no. 93608) distributed only to the special-care nursery on July 26 were found positive for P. pickettii. CDC has confirmed the identity of isolates from infants in this hospital as P. pickettii and has confirmed contamination of the implicated lot with that microorganism. Thirty-nine (65%) of 60 vials from this lot tested by CDC were found positive for P. pickettii; quantitative microbial counts made from all eight of eight contaminated vials tested demonstrated counts of 10,000 organisms/ml. In addition, one (5%) of 20 vials of one other lot of 0.9% NaCl (no. hospital as P. pickettii and has confirmed contamination of the implicated lot with that microorganism. Thirty-nine (65%) of 60 vials from this lot tested by CDC were found positive for P. pickettii; quantitative microbial counts made from all eight of eight contaminated vials tested demonstrated counts of 10,000 organisms/ml. In addition, one (5%) of 20 vials of one other lot of 0.9% NaCl (no. 93489) from this hospital was shown to be contaminated with P. pickettii. Also, P. pickettii has been recovered from two other lots of 0.9% NaCl, and one lot of 0.45% NaCl from two other hospitals. All lots were from the same manufacturer.

Since this report, four additional hospitals have reported respiratory colonization of infants and adults with aerobic, nonfermentative, gram-negative organisms and have associated this colonization with the use of Modu-Dose. In two of these hospitals, organisms cultured from Modu-Dose and patients have been reported as P. pickettii. Reported by B Reisberg, MD, P Blanken, M Wade, E Webb, Northwestern Memorial Hospital, S Shulman, MD, S Gardner, Children's Memorial Hospital, Chicago, KT Reddi, MD, Bureau of Preventive Medicine, City of Chicago Dept of Health, BJ Francis, MD, State Epidemiologist, Illinois State Dept of Health; LA Schneider, MD, D McEvoy, St. Joseph's Hospital, Fort Wayne, CL Barrett, MD, State Epidemiologist, Indiana State Board of Health; MT Brady, MD, Children's Hospital, Columbus, TJ Halpin, MD, State Epidemiologist, Ohio State Dept of Health; DL Leong, PhD, DE Anderson, PhD, Sacred Heart Medical Center, Spokane, JM Kobayashi, MD, State Epidemiologist, Washington State Dept of Social and Health Svcs; M Haffner, MD, National Center of Devices and Radiological Health, I Weitzman, Emergency and Epidemiological Operations Br, U.S. Food and Drug Administration; Div of Field Svcs, Epidemiology Program Office; Div of Bacterial Diseases, Hospital Infections Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Becton Dickinson Respiratory Systems manufactures Modu-Dose as sterile 3-ml and 5-ml vials of water, 0.45% NaCl, and 0.9% NaCl solutions for respiratory therapy use only. Following a microbiologic investigation by the company that confirmed bacterial contamination of some vials of Modu-Dose with P. pickettii, Becton Dickinson Respiratory Systems issued a voluntary product-recall notice on July 25 for all Modu-Dose water and saline solution vials with lot numbers through 93677.

P. pickettii is a slow-growing (optimal temperature 35 C (95 F)) species of aerobic, nonfermentative, gram-negative bacilli (1). Correct identification depends on the performance of a number of conventional biochemical tests (2), and may not always be possible if a laboratory depends on an automated system (3). The P. pickettii strains isolated from the patients and from the vials of Modu-Dose that have been confirmed by CDC belong to the biovar previously designated as Va-2 (oxidizes glucose and xylose but not lactose or maltose). P. pickettii, including Biovars Va-1, Va-2, and P. thomasii, are thought to be of low virulence, although there have been isolated case reports of bacteremia with P. pickettii (Va-2) and acute, nonfatal meningitis with P. pickettii (Va-1) (4,5). P. thomasii has also been responsible for an outbreak of hospital-acquired colonization and infection related to contamination of water purified in a hospital's pharmacy and improper autoclaving technique (6).


  1. Ralston E, Palleroni NJ, Doudoroff M. Pseudomonas pickettii, a new species of clinical origin related to Pseudomonas solanacearum. Int J Syst Bacteriol 1973;23:15-9.

  2. Riley PS, Weaver RE. Recognition of Pseudomonas pickettii in the clinical laboratory: biochemical characterization of 62 strains. J Clin Microbiol 1975;1:61-4.

  3. Chester B, Cleary TJ. Evaluation of the Minitek system for identification of nonfermentative and nonenteric fermentative gram-negative bacteria. J Clin Microbiol 1980;12:509-16.

  4. Fujita S, Yoshida T, Matsubara F. Pseudomonas pickettii bacteremia. J Clin Microbiol 1981;13:781-2.

  5. Fass RJ, Barnishan J. Acute meningitis due to a Pseudomonas-like Group Va-1 bacillus. Ann Intern Med (letter) 1976;84:51-2.

  6. Phillips I, Eykyn S, Laker M. Outbreak of hospital infection caused by contaminated autoclaved fluids. Lancet 1972 1:1258-60.

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