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Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation.

Publication ,  Journal Article
Baker, AW; Lewis, SS; Alexander, BD; Chen, LF; Wallace, RJ; Brown-Elliott, BA; Isaacs, PJ; Pickett, LC; Patel, CB; Smith, PK; Reynolds, JM ...
Published in: Clin Infect Dis
April 1, 2017

BACKGROUND: Nontuberculous mycobacteria (NTM) commonly colonize municipal water supplies and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital. METHODS: Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation. RESULTS: The incidence rate of M. abscessus increased from 0.7 cases per 10000 patient-days during the baseline period (January 2013-July 2013) to 3.0 cases per 10000 patient-days during phase 1 of the outbreak (August 2013-May 2014) (incidence rate ratio, 4.6 [95% confidence interval, 2.3-8.8]; P < .001). Thirty-six of 71 (51%) phase 1 cases were lung transplant patients with positive respiratory cultures. We eliminated tap water exposure to the aerodigestive tract among high-risk patients, and the incidence rate decreased to baseline. Twelve of 24 (50%) phase 2 (December 2014-June 2015) cases occurred in cardiac surgery patients with invasive infections. Phase 2 resolved after we implemented an intensified disinfection protocol and used sterile water for heater-cooler units of cardiopulmonary bypass machines. Molecular fingerprinting of clinical isolates identified 2 clonal strains of M. abscessus; 1 clone was isolated from water sources at a new hospital addition. We made several water engineering interventions to improve water flow and increase disinfectant levels. CONCLUSIONS: We investigated and mitigated a 2-phase clonal outbreak of M. abscessus linked to hospital tap water. Healthcare facilities with endemic NTM should consider similar tap water avoidance and engineering strategies to decrease risk of NTM infection.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

April 1, 2017

Volume

64

Issue

7

Start / End Page

902 / 911

Location

United States

Related Subject Headings

  • Risk Factors
  • Mycobacterium abscessus
  • Mycobacterium Infections, Nontuberculous
  • Multilocus Sequence Typing
  • Middle Aged
  • Microbiology
  • Male
  • Incidence
  • Humans
  • Hospitals
 

Citation

APA
Chicago
ICMJE
MLA
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Baker, A. W., Lewis, S. S., Alexander, B. D., Chen, L. F., Wallace, R. J., Brown-Elliott, B. A., … Sexton, D. J. (2017). Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation. Clin Infect Dis, 64(7), 902–911. https://doi.org/10.1093/cid/ciw877
Baker, Arthur W., Sarah S. Lewis, Barbara D. Alexander, Luke F. Chen, Richard J. Wallace, Barbara A. Brown-Elliott, Pamela J. Isaacs, et al. “Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation.Clin Infect Dis 64, no. 7 (April 1, 2017): 902–11. https://doi.org/10.1093/cid/ciw877.
Baker AW, Lewis SS, Alexander BD, Chen LF, Wallace RJ, Brown-Elliott BA, et al. Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation. Clin Infect Dis. 2017 Apr 1;64(7):902–11.
Baker, Arthur W., et al. “Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation.Clin Infect Dis, vol. 64, no. 7, Apr. 2017, pp. 902–11. Pubmed, doi:10.1093/cid/ciw877.
Baker AW, Lewis SS, Alexander BD, Chen LF, Wallace RJ, Brown-Elliott BA, Isaacs PJ, Pickett LC, Patel CB, Smith PK, Reynolds JM, Engel J, Wolfe CR, Milano CA, Schroder JN, Davis RD, Hartwig MG, Stout JE, Strittholt N, Maziarz EK, Saullo JH, Hazen KC, Walczak RJ, Vasireddy R, Vasireddy S, McKnight CM, Anderson DJ, Sexton DJ. Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation. Clin Infect Dis. 2017 Apr 1;64(7):902–911.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

April 1, 2017

Volume

64

Issue

7

Start / End Page

902 / 911

Location

United States

Related Subject Headings

  • Risk Factors
  • Mycobacterium abscessus
  • Mycobacterium Infections, Nontuberculous
  • Multilocus Sequence Typing
  • Middle Aged
  • Microbiology
  • Male
  • Incidence
  • Humans
  • Hospitals