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Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation
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...
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Published in: | Clinical infectious diseases 2017-04, Vol.64 (7), p.902-911 |
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creator | Baker, Arthur W. Lewis, Sarah S. Alexander, Barbara D. Chen, Luke F. Wallace, Richard J. Brown-Elliott, Barbara A. Isaacs, Pamela J. Pickett, Lisa C. Patel, Chetan B. Smith, Peter K. Reynolds, John M. Engel, Jill Wolfe, Cameron R. Milano, Carmelo A. Schroder, Jacob N. Davis, Robert D. Hartwig, Matthew G. Stout, Jason E. Strittholt, Nancy Maziarz, Eileen K. Saullo, Jennifer Horan Hazen, Kevin C. Walczak, Richard J. Vasireddy, Ravikiran Vasireddy, Sruthi McKnight, Celeste M. Anderson, Deverick J. Sexton, Daniel J. |
description | 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 10 000 patient-days during the baseline period (January 2013–July 2013) to 3.0 cases per 10 000 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. |
doi_str_mv | 10.1093/cid/ciw877 |
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fullrecord | <record><control><sourceid>jstor_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5848312</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>26374555</jstor_id><sourcerecordid>26374555</sourcerecordid><originalsourceid>FETCH-LOGICAL-c502t-a4f894f350142f74c70c0d7266eadb0b43d48a83fb98cd40774864c5da9234813</originalsourceid><addsrcrecordid>eNqNkc9LHTEQx4O0-Kteem9Z8CKFbZNNspntoSBiq6DYgz2H2SSred23eSZZxf_eyFNre-phyIT58GW-8yXkPaOfGe34F-NtqTtQaoNsM8lV3cqOvSk9lVAL4LBFdlJaUMoYULlJthqgSkmmtom-vAv1z2tMrjoJaeUzjvVhSsF4zM5WF3Puo8PfVRiq83sTejTZRT8vK-yTcSnN6Wt1Ot26lP0VZh-mCidbnfvn7zvydsAxub2nd5f8-n58eXRSn138OD06PKuNpE2uUQzQiYFLykQzKGEUNdSqpm0d2p72glsBCHzoOzBWlO0FtMJIi13DBTC-S76tdVdzv3TWuClHHPUq-iXGex3Q678nk7_WV-FWSygHYk0ROHgSiOFmLn700heH44iTC3PSDAA6xZRS_4FKYBSU4AXd_wddhDlO5RKFUl1bIulkoT6tKRNDStENL3szqh8j1iVivY64wB9fO31BnzMtwIc1sEg5xD_zlishpeQP8watBg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1879600195</pqid></control><display><type>article</type><title>Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation</title><source>Oxford Journals Online</source><source>JSTOR Archival Journals</source><creator>Baker, Arthur W. ; Lewis, Sarah S. ; Alexander, Barbara D. ; Chen, Luke F. ; Wallace, Richard J. ; Brown-Elliott, Barbara A. ; Isaacs, Pamela J. ; Pickett, Lisa C. ; Patel, Chetan B. ; Smith, Peter K. ; Reynolds, John M. ; Engel, Jill ; Wolfe, Cameron R. ; Milano, Carmelo A. ; Schroder, Jacob N. ; Davis, Robert D. ; Hartwig, Matthew G. ; Stout, Jason E. ; Strittholt, Nancy ; Maziarz, Eileen K. ; Saullo, Jennifer Horan ; Hazen, Kevin C. ; Walczak, Richard J. ; Vasireddy, Ravikiran ; Vasireddy, Sruthi ; McKnight, Celeste M. ; Anderson, Deverick J. ; Sexton, Daniel J.</creator><creatorcontrib>Baker, Arthur W. ; Lewis, Sarah S. ; Alexander, Barbara D. ; Chen, Luke F. ; Wallace, Richard J. ; Brown-Elliott, Barbara A. ; Isaacs, Pamela J. ; Pickett, Lisa C. ; Patel, Chetan B. ; Smith, Peter K. ; Reynolds, John M. ; Engel, Jill ; Wolfe, Cameron R. ; Milano, Carmelo A. ; Schroder, Jacob N. ; Davis, Robert D. ; Hartwig, Matthew G. ; Stout, Jason E. ; Strittholt, Nancy ; Maziarz, Eileen K. ; Saullo, Jennifer Horan ; Hazen, Kevin C. ; Walczak, Richard J. ; Vasireddy, Ravikiran ; Vasireddy, Sruthi ; McKnight, Celeste M. ; Anderson, Deverick J. ; Sexton, Daniel J.</creatorcontrib><description>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 10 000 patient-days during the baseline period (January 2013–July 2013) to 3.0 cases per 10 000 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.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciw877</identifier><identifier>PMID: 28077517</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Aged ; ARTICLES AND COMMENTARIES ; Bacteria ; Cross Infection ; Disease Outbreaks ; Disinfection & disinfectants ; Drinking water ; Epidemics ; Female ; Genes, Bacterial ; Hospitals ; Humans ; Incidence ; Major ; Male ; Middle Aged ; Multilocus Sequence Typing ; Mycobacterium abscessus ; Mycobacterium abscessus - classification ; Mycobacterium abscessus - genetics ; Mycobacterium Infections, Nontuberculous - diagnosis ; Mycobacterium Infections, Nontuberculous - epidemiology ; Mycobacterium Infections, Nontuberculous - etiology ; Mycobacterium Infections, Nontuberculous - microbiology ; Nosocomial infections ; Risk assessment ; Risk Factors</subject><ispartof>Clinical infectious diseases, 2017-04, Vol.64 (7), p.902-911</ispartof><rights>Copyright © 2017 by Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford University Press, UK Apr 2017</rights><rights>The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-a4f894f350142f74c70c0d7266eadb0b43d48a83fb98cd40774864c5da9234813</citedby><cites>FETCH-LOGICAL-c502t-a4f894f350142f74c70c0d7266eadb0b43d48a83fb98cd40774864c5da9234813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/26374555$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/26374555$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,58238,58471</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28077517$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baker, Arthur W.</creatorcontrib><creatorcontrib>Lewis, Sarah S.</creatorcontrib><creatorcontrib>Alexander, Barbara D.</creatorcontrib><creatorcontrib>Chen, Luke F.</creatorcontrib><creatorcontrib>Wallace, Richard J.</creatorcontrib><creatorcontrib>Brown-Elliott, Barbara A.</creatorcontrib><creatorcontrib>Isaacs, Pamela J.</creatorcontrib><creatorcontrib>Pickett, Lisa C.</creatorcontrib><creatorcontrib>Patel, Chetan B.</creatorcontrib><creatorcontrib>Smith, Peter K.</creatorcontrib><creatorcontrib>Reynolds, John M.</creatorcontrib><creatorcontrib>Engel, Jill</creatorcontrib><creatorcontrib>Wolfe, Cameron R.</creatorcontrib><creatorcontrib>Milano, Carmelo A.</creatorcontrib><creatorcontrib>Schroder, Jacob N.</creatorcontrib><creatorcontrib>Davis, Robert D.</creatorcontrib><creatorcontrib>Hartwig, Matthew G.</creatorcontrib><creatorcontrib>Stout, Jason E.</creatorcontrib><creatorcontrib>Strittholt, Nancy</creatorcontrib><creatorcontrib>Maziarz, Eileen K.</creatorcontrib><creatorcontrib>Saullo, Jennifer Horan</creatorcontrib><creatorcontrib>Hazen, Kevin C.</creatorcontrib><creatorcontrib>Walczak, Richard J.</creatorcontrib><creatorcontrib>Vasireddy, Ravikiran</creatorcontrib><creatorcontrib>Vasireddy, Sruthi</creatorcontrib><creatorcontrib>McKnight, Celeste M.</creatorcontrib><creatorcontrib>Anderson, Deverick J.</creatorcontrib><creatorcontrib>Sexton, Daniel J.</creatorcontrib><title>Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>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 10 000 patient-days during the baseline period (January 2013–July 2013) to 3.0 cases per 10 000 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.</description><subject>Aged</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Bacteria</subject><subject>Cross Infection</subject><subject>Disease Outbreaks</subject><subject>Disinfection & disinfectants</subject><subject>Drinking water</subject><subject>Epidemics</subject><subject>Female</subject><subject>Genes, Bacterial</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Major</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multilocus Sequence Typing</subject><subject>Mycobacterium abscessus</subject><subject>Mycobacterium abscessus - classification</subject><subject>Mycobacterium abscessus - genetics</subject><subject>Mycobacterium Infections, Nontuberculous - diagnosis</subject><subject>Mycobacterium Infections, Nontuberculous - epidemiology</subject><subject>Mycobacterium Infections, Nontuberculous - etiology</subject><subject>Mycobacterium Infections, Nontuberculous - microbiology</subject><subject>Nosocomial infections</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqNkc9LHTEQx4O0-Kteem9Z8CKFbZNNspntoSBiq6DYgz2H2SSred23eSZZxf_eyFNre-phyIT58GW-8yXkPaOfGe34F-NtqTtQaoNsM8lV3cqOvSk9lVAL4LBFdlJaUMoYULlJthqgSkmmtom-vAv1z2tMrjoJaeUzjvVhSsF4zM5WF3Puo8PfVRiq83sTejTZRT8vK-yTcSnN6Wt1Ot26lP0VZh-mCidbnfvn7zvydsAxub2nd5f8-n58eXRSn138OD06PKuNpE2uUQzQiYFLykQzKGEUNdSqpm0d2p72glsBCHzoOzBWlO0FtMJIi13DBTC-S76tdVdzv3TWuClHHPUq-iXGex3Q678nk7_WV-FWSygHYk0ROHgSiOFmLn700heH44iTC3PSDAA6xZRS_4FKYBSU4AXd_wddhDlO5RKFUl1bIulkoT6tKRNDStENL3szqh8j1iVivY64wB9fO31BnzMtwIc1sEg5xD_zlishpeQP8watBg</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Baker, Arthur W.</creator><creator>Lewis, Sarah S.</creator><creator>Alexander, Barbara D.</creator><creator>Chen, Luke F.</creator><creator>Wallace, Richard J.</creator><creator>Brown-Elliott, Barbara A.</creator><creator>Isaacs, Pamela J.</creator><creator>Pickett, Lisa C.</creator><creator>Patel, Chetan B.</creator><creator>Smith, Peter K.</creator><creator>Reynolds, John M.</creator><creator>Engel, Jill</creator><creator>Wolfe, Cameron R.</creator><creator>Milano, Carmelo A.</creator><creator>Schroder, Jacob N.</creator><creator>Davis, Robert D.</creator><creator>Hartwig, Matthew G.</creator><creator>Stout, Jason E.</creator><creator>Strittholt, Nancy</creator><creator>Maziarz, Eileen K.</creator><creator>Saullo, Jennifer Horan</creator><creator>Hazen, Kevin C.</creator><creator>Walczak, Richard J.</creator><creator>Vasireddy, Ravikiran</creator><creator>Vasireddy, Sruthi</creator><creator>McKnight, Celeste M.</creator><creator>Anderson, Deverick J.</creator><creator>Sexton, Daniel J.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>20170401</creationdate><title>Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation</title><author>Baker, Arthur W. ; Lewis, Sarah S. ; Alexander, Barbara D. ; Chen, Luke F. ; Wallace, Richard J. ; Brown-Elliott, Barbara A. ; Isaacs, Pamela J. ; Pickett, Lisa C. ; Patel, Chetan B. ; Smith, Peter K. ; Reynolds, John M. ; Engel, Jill ; Wolfe, Cameron R. ; Milano, Carmelo A. ; Schroder, Jacob N. ; Davis, Robert D. ; Hartwig, Matthew G. ; Stout, Jason E. ; Strittholt, Nancy ; Maziarz, Eileen K. ; Saullo, Jennifer Horan ; Hazen, Kevin C. ; Walczak, Richard J. ; Vasireddy, Ravikiran ; Vasireddy, Sruthi ; McKnight, Celeste M. ; Anderson, Deverick J. ; Sexton, Daniel J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-a4f894f350142f74c70c0d7266eadb0b43d48a83fb98cd40774864c5da9234813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Bacteria</topic><topic>Cross Infection</topic><topic>Disease Outbreaks</topic><topic>Disinfection & disinfectants</topic><topic>Drinking water</topic><topic>Epidemics</topic><topic>Female</topic><topic>Genes, Bacterial</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Major</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multilocus Sequence Typing</topic><topic>Mycobacterium abscessus</topic><topic>Mycobacterium abscessus - classification</topic><topic>Mycobacterium abscessus - genetics</topic><topic>Mycobacterium Infections, Nontuberculous - diagnosis</topic><topic>Mycobacterium Infections, Nontuberculous - epidemiology</topic><topic>Mycobacterium Infections, Nontuberculous - etiology</topic><topic>Mycobacterium Infections, Nontuberculous - microbiology</topic><topic>Nosocomial infections</topic><topic>Risk assessment</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baker, Arthur W.</creatorcontrib><creatorcontrib>Lewis, Sarah S.</creatorcontrib><creatorcontrib>Alexander, Barbara D.</creatorcontrib><creatorcontrib>Chen, Luke F.</creatorcontrib><creatorcontrib>Wallace, Richard J.</creatorcontrib><creatorcontrib>Brown-Elliott, Barbara A.</creatorcontrib><creatorcontrib>Isaacs, Pamela J.</creatorcontrib><creatorcontrib>Pickett, Lisa C.</creatorcontrib><creatorcontrib>Patel, Chetan B.</creatorcontrib><creatorcontrib>Smith, Peter K.</creatorcontrib><creatorcontrib>Reynolds, John M.</creatorcontrib><creatorcontrib>Engel, Jill</creatorcontrib><creatorcontrib>Wolfe, Cameron R.</creatorcontrib><creatorcontrib>Milano, Carmelo A.</creatorcontrib><creatorcontrib>Schroder, Jacob N.</creatorcontrib><creatorcontrib>Davis, Robert D.</creatorcontrib><creatorcontrib>Hartwig, Matthew G.</creatorcontrib><creatorcontrib>Stout, Jason E.</creatorcontrib><creatorcontrib>Strittholt, Nancy</creatorcontrib><creatorcontrib>Maziarz, Eileen K.</creatorcontrib><creatorcontrib>Saullo, Jennifer Horan</creatorcontrib><creatorcontrib>Hazen, Kevin C.</creatorcontrib><creatorcontrib>Walczak, Richard J.</creatorcontrib><creatorcontrib>Vasireddy, Ravikiran</creatorcontrib><creatorcontrib>Vasireddy, Sruthi</creatorcontrib><creatorcontrib>McKnight, Celeste M.</creatorcontrib><creatorcontrib>Anderson, Deverick J.</creatorcontrib><creatorcontrib>Sexton, Daniel J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baker, Arthur W.</au><au>Lewis, Sarah S.</au><au>Alexander, Barbara D.</au><au>Chen, Luke F.</au><au>Wallace, Richard J.</au><au>Brown-Elliott, Barbara A.</au><au>Isaacs, Pamela J.</au><au>Pickett, Lisa C.</au><au>Patel, Chetan B.</au><au>Smith, Peter K.</au><au>Reynolds, John M.</au><au>Engel, Jill</au><au>Wolfe, Cameron R.</au><au>Milano, Carmelo A.</au><au>Schroder, Jacob N.</au><au>Davis, Robert D.</au><au>Hartwig, Matthew G.</au><au>Stout, Jason E.</au><au>Strittholt, Nancy</au><au>Maziarz, Eileen K.</au><au>Saullo, Jennifer Horan</au><au>Hazen, Kevin C.</au><au>Walczak, Richard J.</au><au>Vasireddy, Ravikiran</au><au>Vasireddy, Sruthi</au><au>McKnight, Celeste M.</au><au>Anderson, Deverick J.</au><au>Sexton, Daniel J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>64</volume><issue>7</issue><spage>902</spage><epage>911</epage><pages>902-911</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>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 10 000 patient-days during the baseline period (January 2013–July 2013) to 3.0 cases per 10 000 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.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>28077517</pmid><doi>10.1093/cid/ciw877</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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ispartof | Clinical infectious diseases, 2017-04, Vol.64 (7), p.902-911 |
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language | eng |
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source | Oxford Journals Online; JSTOR Archival Journals |
subjects | Aged ARTICLES AND COMMENTARIES Bacteria Cross Infection Disease Outbreaks Disinfection & disinfectants Drinking water Epidemics Female Genes, Bacterial Hospitals Humans Incidence Major Male Middle Aged Multilocus Sequence Typing Mycobacterium abscessus Mycobacterium abscessus - classification Mycobacterium abscessus - genetics Mycobacterium Infections, Nontuberculous - diagnosis Mycobacterium Infections, Nontuberculous - epidemiology Mycobacterium Infections, Nontuberculous - etiology Mycobacterium Infections, Nontuberculous - microbiology Nosocomial infections Risk assessment Risk Factors |
title | Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation |
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