Mycobacteroides abscessus outbreak and mitigation in a cardiothoracic transplant population: the problem with tap water.

Autor: Rathod SN; Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA. Electronic address: shardul.rathod@nm.org., Weber RT; Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA., Salim AA; Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial HealthCare, Chicago, IL, USA., Tanna SD; Division of Infectious Disease, Department of Medicine, Inova Fairfax Medical Center, Falls Church, VA, USA., Stosor V; Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Malczynski M; Department of Pathology, Northwestern University Feinberg School of Medicine, Clinical Microbiology Laboratory, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA., O'Boye A; Department of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Hoke K; Cardiac Intensive Care Unit, Northwestern Medicine Central DuPage Hospital, Chicago, IL, USA., Landon J; Pulmonary Medicine, Northwestern Memorial Hospital, Chicago, IL, USA., McCarthy S; Cardiac, Vascular, and Thoracic Stepdown, Northwestern Memorial Hospital, Chicago, IL, USA., Qi C; Department of Pathology, Northwestern University Feinberg School of Medicine, Clinical Microbiology Laboratory, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Angarone MP; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Ison MG; Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, NIAID/NIH, Rockville, MD, USA., Williams JL; Division of Infectious Diseases, Corewell Health Medical Group, Michigan State University College of Human Medicine, Grand Rapids, MI, USA., Zembower TR; Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA; Department of Pathology, Northwestern University Feinberg School of Medicine, Clinical Microbiology Laboratory, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Bolon MK; Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL, USA; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Nov 07; Vol. 155, pp. 150-157. Date of Electronic Publication: 2024 Nov 07.
DOI: 10.1016/j.jhin.2024.10.016
Abstrakt: Background: Hospital outbreaks caused by Mycobacteroides abscessus complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population.
Aim: To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated M. abscessus complex cases in an inpatient cardiothoracic transplant population.
Methods: We extracted clinical characteristics from patients with M. abscessus pre-outbreak (March 2018 to December 2020) and during the outbreak (January 2021 to June 2022) from the electronic medical record. A multi-disciplinary team conducted the outbreak investigation and devised a mitigation strategy to implement at our institution.
Findings: The baseline incidence of healthcare-associated M. abscessus was 0.11 cases per 10,000 patient-days; this increased to 0.24 cases per 10,000 patient-days during the outbreak. There were 1/9 (11%) cardiothoracic transplant patients in the pre-outbreak group compared with 7/12 (58%) during the outbreak, and respiratory specimen types compromised 6/9 (67%) of M. abscessus results in the pre-outbreak group compared with 10/12 (83%) during the outbreak. Among the clinical care activities involving water, a variety of water sources were utilized, including filtered and tap water. The incidence of healthcare-associated M. abscessus subsequently decreased to 0.06 cases per 10,000 patient-days after implementing an outbreak-mitigation strategy of sterile water precautions.
Conclusions: Robust educational efforts from a multi-disciplinary team on eliminating exposure to tap water were effective measures to reduce healthcare-associated M. abscessus incidence at our institution. Non-tuberculous mycobacteria infection surveillance, targeted education, and water mitigation strategies may be beneficial preventative strategies for other lung transplant centres facing similar issues.
Competing Interests: Conflict of interest statement M.P.A. is a consultant for Abbvie. M.G.I. declares that research support from GSK was paid to Northwestern; received consulting fees from Adagio Therapeutics, ADMA Biologics, Adamis Pharmaceuticals, AlloVir, Atea, Cidara Therapeutics, Genentech/Roche, Janssen, Shionogi, Takeda, Telaris, and Eurofins Viracor; and payment for participating in data safety monitoring boards or advisory boards from Adamis Pharmaceuticals, AlloVir, National Institutes of Health, CSL Behring, Janssen, Merck, Seqirus, Takeda, and Talaris; all of these ended December 2022; he also receives author royalties from UpToDate, which is ongoing; M.G.I. also serves as Chair of the International Society for Influenza and other Respiratory Virus Diseases Antiviral Group and was Editor-in-Chief of Transplant Infectious Disease. All other authors report no conflicts of interest relevant to this article.
(Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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