Pseudomonas cepacia: implications and control of epidemic nosocomial colonization

In the 19-month period January 1979-July 1980, 56 patients became colonized or infected with Pseudomonas cepacia. Three groups of patients were identified. In group I, six otolaryngology patients became colonized when contaminated aqueous cocaine was used as a topical anesthetic. In group II, 24 patients became colonized from contaminated lidocaine normal-saline solutions that had been drawn into syringes in advance (setups) and used during bronchoscopy in the internal medicine department. In group III, the source of colonization of infection for 26 patients with sputum, wound, blood, or urine cultures positive for P. cepacia was not determined. However, contaminated aqueous cocaine, found in the pharmacy, had been given to several of these patients. Since most patients were colonized rather than infected with P. cepacia, there was an apparent disparity in the case count based on data obtained from microbiology records and data obtained from ongoing surveillance of nosocomial infections. Several patients who were merely colonized with P. cepacia were inappropriately treated with chloramphenicol. Successful control measures included sterilizing cocaine solutions in the otolaryngology department and in the pharmacy and eliminating contaminated set-ups in the internal medicine department.