Physicians should determine whether patients with respiratory illness play a woodwind or brass instrument

Glass RT. Gen Dent. 2011;59:100-107.

Used woodwind and brass instruments were found to be contaminated with a variety of microbial flora associated with infectious and allergic diseases, according to researchers.

“[Physicians] should determine whether patients play a brass or woodwind instrument and be aware of the possible impact of this activity on the oral cavity and the entire body,” wrote researcher R. Thomas Glass, DDS, PhD, a professor of forensic sciences, pathology and dental medicine at Oklahoma State University.

Glass and colleagues sampled microbial flora from 13 de-identified woodwind (n=6) and brass (n=7) instruments from a high school band. Six had been played within a week before testing; the others had not been played for at least 1 month before testing. Researchers tested 117 sites on the instruments, including mouthpieces, internal chambers and instrument cases; reeds were tested separately. A total of 295 different isolates were found, averaging 2.5 isolates per site.

Based on colony appearance, morphology, Gram’s stain reaction and biochemical means, 32.2% of isolates were gram-positive cocci, 44.4% were gram-positive bacilli and 23.4% were gram-negative bacilli. No gram-negative cocci were found. One instrument was found positive for Staphylococcus aureus. The most frequently isolated bacteria and fungi were Brevibacterium spp. and Penicillium chrysogenum, respectively.

Researchers found higher bacterial loads in woodwind instruments than in brass ones (P=.1547); reeds were more contaminated than mouthpieces (P=.0496); and a low correlation between bacterial load the last time an instrument was played (correlation coefficient=0.1520). All gram-positive cocci were tested for antimicrobial resistance; high methicillin resistance was found in isolates of S. aureus and S. spp.

“Many children participate in their school’s band ensemble and often the instruments they play are on loan,” Glass said in a press release. “Most of these instruments have been played by other students, and without the proper sanitation, bacteria and fungi can thrive for weeks and even months after the last use.”

Glass RT. Gen Dent. 2011;59:100-107.

Disclosure: The researchers report no relevant financial disclosures.

This microbiologic study of 13 musical woodwind instruments uncovered numerous nonpathogens of fungi and bacteria, and even a commonly carried nasopharyngeal isolate of Staphylococcus aureus (normally found in about 10% to 30% of folks). To ask clinicians to screen for patient use of musical instruments, when only nonpathogens and a single frequent commensal have been found, seems incredibly onerous. No Legionnaires' or Streptococcus pyogenes, for instance, were identified. This is an interesting scientific observation of no identifiable practical consequence. More time spent encouraging better hand washing hygiene is immensely more likely to be productive.

–Stan L. Block, MD

Infectious Diseases in Children Editorial Board member

Follow the PediatricSuperSite.com on Twitter.