Esophagoscopy as a source of Pseudomonas aeruginosa sepsis in patients with acute leukemia: the need for sterilization of endoscopes

A fortuitous series of clinical events led to a review of the culture reports and clinical records of all Baltimore Cancer Research Center patients undergoing endoscopy with a flexible fiberoptic esophagoscope in use since July, 1972. Of 12 such patients, 3, with acute leukemia, grew, from endoscopic cultures of esophageal washings and/or tissue, serotypes of Pseudomonas aeruginosa never previously recovered from the patient despite extensive, twice weekly cultures of nose, throat, axilla, perirectal area, and urine. Esophageal mucosal biopsy was performed at the time of endoscopy in 2 of these 3 patients. Each was severely granulocytopenic and in both patients fatal Pseudomonas septicemia followed endoscopy, 12 hr and 3 days later. Cultures of the esophagoscope and of the endoscopy room revealed widespread contamination by enteric organisms, including Pseudomonas aeruginosa, and routine handling of the instrument ignored aseptic technique. Endoscopy, particularly with biopsy, in the compromised host carries the dual risk of inducing sepsis from endogenous flora and of introduction of invasive nosocomial organisms, especially Pseudomonas aeruginosa.