DOMICILIARY METAPROTERENOL NEBULIZATION - A BACTERIOLOGIC SURVEY

[摘要] We wanted to determine whether domiciliary jet nebulization (DJN) leads to contamination of the equipment with fungi or aerobic and, eventually, to respiratory colonization or pneumonia in daily users of the equipment. We surveyed from this standpoint 23 veterans 65 .+-. 10.1 years of age, present or former smokers, treated with steroids more than 7 months in the year preceding the survey, and with FEV1/FVC of 42 .+-. 11%; they all were daily users of the equipment, diluting the metaoproterenol solution with nonbacteriostatic saline dispensed in multiple-dose bottles of 500 to 1000 ml (protocol 1 [P1]). After this protocol was completed, the large saline bottles were replaced by 20 cc vials; 11/23 completed 1 year of this treatment (protocol 2 [P2]). Equipment contamination was checked in all initial 23 patients after one-time nebulization in the laboratory with fresh material (protocol 3 [P3]). We found that DJN leads to equipment contamination in 20/23 subjects of P1 and 3/11 subjects of p2; saline bottles and the nebulizer were the most frequently contaminated items (32/41 equipment items in P1 and 10/55 in P2). The contamination was predoinantly bacterial with oropharyngeal saprophytes (19 in p1, 0 in P2) or gram-negative bacilli (47 in P1, 8 in P2). Bacterial growth was heavier in P1 than in P2. During P3, three equipment items became contaminated in 3/23 subjects; the flora was oropharyngeal. No patient developed respiratory colonization or developed pneumonia during 9000 patients days of DJN. We conclude (1) that DJN frequently contaminates the nebulization equipment, but even in patients with deficient defense mechanisms, it does not produce respiratory colonization or pneumonia, (2) that saline is the major culprit in contamination, apparently in proportion with the number of bottle manipulations and storage duration of used bottles, and (3) that as a clean technique of jet nebulization leads to a negligible contamination, it is feasible to decrease contamination in DJN by appropriate precautions.

[发布日期] 1988-08-01