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Pseudo-outbreak of Mycobacterium abscessus Infection Caused by Laboratory Contamination

Published online by Cambridge University Press:  02 January 2015

D. B. Blossom ,
K. A. Alelis ,
D. C. Chang ,
A. H. Flores ,
J. Gill ,
D. Beall ,
A. M. Peterson ,
B. Jensen ,
J. Noble-Wang  and
M. Williams
...Show all authors
D. B. Blossom*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
K. A. Alelis
Affiliation:
Pinellas County Health Department, Florida
D. C. Chang
Affiliation:
Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
A. H. Flores
Affiliation:
Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
J. Gill
Affiliation:
Pinellas County Health Department, Florida
D. Beall
Affiliation:
Florida Department of Health, Florida
A. M. Peterson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
B. Jensen
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
J. Noble-Wang
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
M. Williams
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
M. A. Yakrus
Affiliation:
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
M. J. Arduino
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
A. Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Rd. MS-A35, Atlanta, GA 30333 ([email protected])
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Abstract

Objective.

To investigate the cause(s) of an increased incidence of clinical cultures growing Mycobacterium abscessus at a hospital in Florida.

Design.

Outbreak investigation.

Setting.

University-affiliated, tertiary-care hospital.

Methods.

A site visit was done during the first week of September 2006. We reviewed the medical records of patients from whom M. abscessus was recovered during the period from January 1, 2003, through June 30, 2006. We collected environmental samples from various sites and evaluated specimen processing procedures in the microbiology laboratory. Isolates of M. abscessus recovered from the environment and from 12 randomly selected patients who sought medical care in 2006 were compared by pulsed-field gel electrophoresis (PFGE). Follow-up case surveillance was continued through March 31, 2007.

Results.

Specimens from 143 patients obtained from various anatomical sites grew M. abscessus on culture in 2005-2006, compared with specimens from 21 patients in 2003-2004. The 12 isolates from patients that were selected for molecular typing had indistinguishable PFGE patterns. Observations revealed no major breaches in the processing of mycobacterial specimens in the laboratory. Isolates grew only after prolonged incubation (mean ± SD, 45 ± 15 days) in test tubes containing diagonally oriented Middlebrook and Cohn 7H10 agar or Lowenstein-Jensen medium. Environmental samples obtained from the inside of the specimen incubator grew M. abscessus on culture. A test tube containing diagonally oriented, uninoculated Middlebrook and Cohn 7H10 agar that was incubated in the same incubator as clinical specimens grew M. abscessus with a PFGE pattern that matched the pattern of the patient isolates. Cases of M. abscessus infection decreased to baseline after the hospital changed suppliers of mycobacterial media and cleaned the incubator.

Conclusions.

Although the source was never confirmed, our investigation suggests that this was a pseudo-outbreak of M. abscessus infection that resulted from contamination of mycobacterial cultures during incubation. Our findings emphasize the need for guidance on the disinfection of specimen incubators.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 57 - 62
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.De Groote, MA, Huitt, G. Infections due to rapidly growing mycobacteria. Clin Infect Dis 2006;42:1756–1763.CrossRefGoogle ScholarPubMed
2.Cullen, AR, Cannon, CL, Mark, EJ, Colin, AA. Mycobacterium abscessus infection in cystic fibrosis: colonization or infection? Am J Respir Crit Care Med 2000;161:641–645.CrossRefGoogle ScholarPubMed
3.Inman, PM, Beck, A, Brown, AE, Stanford, JL. Outbreak of injection abscesses due to Mycobacterium abscessus. Arch Dermatol 1969;100:141–147.CrossRefGoogle ScholarPubMed
4.Borghans, JG, Stanford, JL. Mycobacterium chelonei in abscesses after injection of diphtheria-pertussis-tetanus-polio vaccine. Am Rev Respir Dis 1973;107:1–8.Google ScholarPubMed
5.Fraser, VJ, Jones, M, Murray, PR, Medoff, G, Zhang, Y, Wallace, RJ. Contamination of flexible fiberoptic bronchoscopes with Mycobacterium che-lonae linked to an automated bronchoscope disinfection machine. Am Rev Respir Dis 1992;145:853–855.CrossRefGoogle Scholar
6.Kuritsky, JN, Bullen, MG, Broome, CV, Silcox, VA, Good, RC, Wallace, RJ. Sternal wound infections and endocarditis due to organisms of the M. fortuitum complex. Ann Intern Med 1983;98:938–939.Google Scholar
7.Newman, MI, Camberas, AE, Ascherman, J. Mycobacteria abscessus outbreak in US patients linked to offshore surgicenter. Ann Plast Swrg 2005;55:107–110.CrossRefGoogle ScholarPubMed
8.Wenger, JD, Spika, JS, Smithwick, RW, et al.Outbreak of Mycobacterium chelonae infection associated with use of jet injectors. JAMA 1990;264:373–376.CrossRefGoogle ScholarPubMed
9.Galil, K, Miller, LA, Yakrus, MA, et al.Abscesses due to Mycobacterium abscessus linked to injection of unapproved alternative medication. Emerg Infect Dis 1999;5:681–687.CrossRefGoogle ScholarPubMed
10.Tiwari, TS, Ray, B, Jost, KC, et al.Forty years of disinfectant failure: outbreak of postinjection Mycobacterium abscessus infection caused by contamination of benzalkonium chloride. Clin Infect Dis 2003;36:954–962.Google Scholar
11.Zhibang, Y, BiXia, Z, Qishan, L, Lihao, C, Xiangquan, L, Huaping, L. Large-scale outbreak of infection with Mycobacterium chelonae subsp. abscessus after penicillin injection. J Clin Microbiol 2002;40:2626–2628.CrossRefGoogle ScholarPubMed
12.Maloney, S, Welbel, S, Daves, B, et al.Mycobacterium abscessus pseudoinfection traced to an automated endoscope washer: utility of epidemiologic and laboratory investigation. J Infect Dis 1994;169:1166–1169.CrossRefGoogle Scholar
13.Ashford, DA, Kellerman, S, Yakrus, M, et al.Pseudo-outbreak of septicemia due to rapidly growing mycobacteria associated with extrinsic contamination of culture supplement. J Clin Microbiol 1997;35:2040–2042.CrossRefGoogle ScholarPubMed
14.Lai, KK, Brown, BA, Westerling, JA, Fontecchio, SA, Zhang, Y, Wallace, RJ. Long-term laboratory contamination by Mycobacterium abscessus resulting in 2 pseudo-outbreaks: recognition with use of random amplified polymorphic DNA (RAPD) polymerase chain reaction. Clin Infect Dis 1998;27:169–175.CrossRefGoogle Scholar
15.Horan, TC, Gaynes, R. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott Williams & Wilkins, 2004:1659–1702.Google Scholar
16.Norton, CD, LeChevallier, MW, Falkinham, JO 3rd. Survival of Mycobacterium avium in a model distribution system. Wat Res 2004;38:1457–1466.Google Scholar
17.Wallace, RJ, Zhang, Y, Brown, BA, Fraser, V, Mazurek, GH, Maloney, S. DNA large restriction fragment patterns of sporadic and epidemic nosocomial strains of Mycobacterium chelonae and Mycobacterium abscessus. J Clin Microbiol 1993;31:2697–2701.CrossRefGoogle ScholarPubMed
18.Zhang, Y, Yakrus, MA, Graviss, EA, et al.Pulsed-field gel electrophoresis study of Mycobacterium abscessus isolates previously affected by DNA degradation. J Clin Microbiol 2004;42:5582–5587.Google Scholar
19.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
20.Balows, A, Hausler, WJ JrHerrmann, KL, Isenberg, HD, Shadomy, HJ, ed. Manual of Clinical Microbiology 5th ed. Washington, DC: American Society for Microbiology; 1991.Google Scholar
21.Della-Latta, P. Digestion-decontamination procedures. In: Delia-Latta, P, ed. Mycobacteriology and Antimycobacterial Susceptibility Testing. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. 2nd ed. Washington, DC: American Society for Microbiology; 2004:7.1.2.1–7.1.2.5.Google Scholar
22.Chapin, KC. Pseudoepidemic of M. avium-intracellulare complex associated with manufactured product. In: Programs and abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy (Washington, DC). Washington, DC; American Society for Microbiology, 1994:243. Abstract J256.Google Scholar
23.Tokars, JI, McNeil, MM, Tablan, OC, et al.Mycobacterium gordonae pseudoinfection associated with a contaminated antimicrobial solution. J Clin Microbiol 1990;28:2765–2769.CrossRefGoogle ScholarPubMed
24.Wallace, RJ, Brown, BA, Griffith, DE. Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. Annu Rev Microbiol 1998;52:453–490.CrossRefGoogle ScholarPubMed
25.Cook, JH. Incubator. In: Della-Latta, P, Vellozzi, EM, eds. Instrument Maintenance and Quality Control. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1992:12.12.1–12.12.13.Google Scholar
26.Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. 2nd ed. Washington, DC: American Society for Microbiology; 2004.Google Scholar