Diversity and Sources of Rapidly Growing Mycobacteria Associated with Infections Following Cardiac Surgery

Abstract

Eighty-nine isolates of rapidly growing mycobacteria associated with cardiac bypass-related infections were characterized. Isolates from sporadic infections belonged to eight taxonomic groups and displayed numerous multilocus enzyme genotypes, plasmid profiles, and heavy metal and antibiotic resistance patterns. Compared with 449 noncardiac wound isolates, 45 sporadic cardiac isolates were more likely to be Mycobacterium fortuitum and M. smegmatis and less likely to be M. chelonae. About 80% of cardiac and noncardiac isolates were from southern coastal states. Eight outbreaks of cardiac bypass-related infections were identified. Strains from each outbreak were genotypically distinctive, and five outbreaks involved more than one strain. In two outbreaks, isolates from environmental sources and noncardiac infections were similar or identical to isolates from sternal wound infections. The heterogeneity of these isolates suggests that most isolates are unrelated and are derived from local environmental sources rather than from contaminated commercial surgical materials or devices.

Iatrogenic outbreak of M. chelonae skin abscesses

“…(15), open heart and cardiac surgery [16,19,38], mammoplasty [17], dialysis [20][21][22] and in people who had undergone invasive procedures at a podiatry office [18]. In Colombia, since 1981, there have been reports of isolated cases with soft tissue lesions [14].…”

“…Wallace discusses the importance of geographic location, seasonal factors, adequacy of air filtration and the presence of nonsterile water in the operating room [38].…”

Micobacteriosis diseminada con compromiso de válvula aórtica protésica: primer caso de Mycobacterium peregrinum de tipo III reportada en Colombia

“…Rapidly growing mycobacteria are not usually pathogenic for humans but they can cause several type of infections including skin and soft tissue infections, osteomyelitis, lymphadenitis, disseminated disease, meningitis, postsurgical wound infections, infections of prostethic devices, and chronic lung disease (3)(4)(5)(6)(7)(15)(16)(17)(18). Some cases have been described in Colombia (8,11).…”

“…In clinical conditions, rapidly growing mycobacteria have been related to skin and soft tissue infections (frequently postsurgical wound infections), pulmonary disease, and colonization of implanted materials such as prosthetics, catheters and sutures; these infections could result in sepsis and disseminated disease (3)(4)(5)(6)(7). Clinical cases of environmental opportunistic mycobacteria, including rapidly growing mycobacteria, have been reported in Colombia (8)(9)(10)(11).…”

Hand Hygiene

“…A Medline search from 1966 to 2001 found 43 such outbreaks, of which 69% (29) could be linked by epidemiological and molecular evidence to biofilms (a community of microorganisms growing as a slimy layer on surfaces immersed in a liquid) in water storage tanks, tap water, and water from showers. [229][230][231][232] Pathogens identified in waterborne nosocomial infections include: Legionella spp., P. aeruginosa, 233,234 Stenotrophomonas maltophilia, 235 Mycobacterium avium, 236 M. fortuitum, 237 M. chelonae, 238 Fusarium spp., 239 and A. fumigatus. 240 Even if hand hygiene practices are in place, a plausible route for transmitting these organisms from water to patient could be through HCWs' hands if contaminated water is used to wash them.…”