CLINICAL-FEATURES OF PSEUDOMONAS-CEPACIA PNEUMONIA IN AN EPIDEMIC AMONG IMMUNOCOMPROMISED PATIENTS

Between January 1990 and August 1991, there were 37 patients admitted to our Department of Internal Medicine with hematologic malignancies or solid tumors who showed colonization of the respiratory tract with Pseudomonas cepacia. Extensive surveillance cultures of the environmental surfaces and respiratory equipment of the hospital revealed that all nebulizing devices were contaminated with P cepacia. To characterize this outbreak, we retrospectively reviewed the medical records of 37 patients colonized with this organism. All had used nebulizers to deliver aerosols containing polymyxin B and amphotericin B as prophylaxis against infection. Sixteen of these 37 patients developed pneumonia, which was caused in 14 by P cepacia. The majority of the 14 patients showed lobular infiltrates on chest x-ray films. Cavity formation and pleural effusion were observed in 4 of the 14 (29 percent). All strains of P cepacia were resistant to piperacillin, cefotiam, sulbactam/cefoperazone, moxalactam (latamoxef), cefuzonam, amikacin, tobramycin, ofloxacin, imipenem, and carumonam. Ceftazidime was effective against 84.7 percent of the strains, while minocycline was effective against 63.5 percent of the strains. This appears to be the first report to describe the clinical features of an epidemic of nosocomial P cepacia pneumonia in immunocompromised patients.