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Outbreak of Mycobacterium mucogenicum Bloodstream Infections among Patients with Sickle Cell Disease in an Outpatient Setting

Published online by Cambridge University Press:  02 January 2015

Muhammad Salman Ashraf ,
Marian Swinker ,
Kerri L. Augustino ,
Delores Nobles ,
Charles Knupp ,
Darla Liles ,
John Christie  and
Keith M. Ramsey
Muhammad Salman Ashraf*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina Department of Family Medicine, Division of Geriatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina Department of Infection Control, Vidant Medical Center, Greenville, North Carolina
Marian Swinker
Affiliation:
Department of Prospective Health, Brody School of Medicine at East Carolina University, Greenville, North Carolina
Kerri L. Augustino
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina Department of Infection Control, Vidant Medical Center, Greenville, North Carolina
Delores Nobles
Affiliation:
Department of Infection Control, Vidant Medical Center, Greenville, North Carolina
Charles Knupp
Affiliation:
Department of Internal Medicine, Division of Hematology/Oncology, Brody School of Medicine at East Carolina University, Greenville, North Carolina
Darla Liles
Affiliation:
Department of Internal Medicine, Division of Hematology/Oncology, Brody School of Medicine at East Carolina University, Greenville, North Carolina
John Christie
Affiliation:
Department of Pathology and Laboratory Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina
Keith M. Ramsey
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina Department of Infection Control, Vidant Medical Center, Greenville, North Carolina
*
Division of Infectious Diseases, and International Travel Clinic, Doctors Park 6A, Greenville, NC 27834. ECU Mailstop 715 Infectious Diseases ([email protected])
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Abstract

Objective.

To study an outbreak of Mycobacterium mucogenicum bloodstream infections in an outpatient setting.

Design.

Outbreak investigation and retrospective chart review.

Setting.

University outpatient clinic.

Patients.

Patients whose blood cultures tested positive for M. mucogenicum in May or June 2008.

Methods.

An outbreak investigation and a review of infection control practices were conducted. During the process, environmental culture samples were obtained. Isolates from patients and the environment were genotyped with the DiversiLab typing system to identify the source. Chart reviews were conducted to study the management and outcomes of the patients.

Results.

Four patients with sickle cell disease and implanted ports followed in the same hematology outpatient clinic developed blood cultures positive for M. mucogenicum. A nurse in the clinic had prepared intravenous port flushes on the sink counter, using a saline bag that was hanging over the sink throughout the shift. None of the environmental cultures grew M. mucogenicum except for the tap water from 2 rooms, 1 of which had a faucet aerator. The 4 patient isolates and the tap water isolate from the room with the aerator were found to have greater than 98.5% similarity. The subcutaneous ports were removed, and patients cleared their infections after a course of antibiotic therapy.

Conclusion.

The source of the M. mucogenicum bacteremia outbreak was identified by genotyping analysis as the clinic tap water supply. The preparation of intravenous medications near the sink was likely an important factor in transmission, along with the presence of a faucet aerator.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1132 - 1136
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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