Infections with Mycobacterium chelonei in Patients Receiving Dialysis and Using Processed Hemodialyzers

Abstract

Between April and November 1982, 27 of 140 patients in a hemodialysis center in Louisiana were infected with rapidly growing mycobacteria; 14 had bacteremia alone, 3 had soft-tissue infections, 1 had an access-graft infection, and 9 had widely disseminated disease. Of 26 identified isolates, 25 were Mycobacterium chelonei ssp. abscessus, and one was an M. chelonei-like organism. One factor common to all patients was exposure to processed hemodialyzers (artificial kidneys). Environmental sampling of the water-treatment system showed widespread contamination with nontuberculous mycobacteria, which were also recovered from the patient's side (blood compartment) of five of 31 hemodialyzers that had been processed and were ready for use. The formaldehyde concentration was less than 2% in two of three such contaminated dialyzers tested. We hypothesize that patients became infected when their blood circulated through processed dialyzers that contained viable rapidly growing mycobacteria. This outbreak demonstrates that hemodialysis patients may be at risk for developing infections with rapidly growing mycobacteria and that such infections may go unrecognized when routine culture methods are used. It also emphasizes the importance of using effective procedures to disinfect dialyzers in hemodialysis centers.

Mycobacterium immunogenum sp. nov., a novel species related to Mycobacterium abscessus and associated with clinical disease, pseudo-outbreaks and contaminated metalworking fluids: an international cooperative study on mycobacterial taxonomy.

“…nov. for these isolates. The specific epithet refers to the association of these mycobacterial isolates with cases of HP (Bolan et al, 1985 ;Kreiss & Cox-Ganser, 1997 ;Muilenberg et al, 1993 Isolates are susceptible in vitro to amikacin and clarithromycin and resistant to cefoxitin (MIC 256 µg ml −" ), cefmetazole, ciprofloxacin, doxycycline, imipenem, sulfamethoxazole and tobramycin (MIC 16 µg ml −" ). They are positive for 3-d arylsulfatase activity, negative for iron uptake and nitrate reductase, do not grow on Lo$ wenstein-Jensen medium containing 5 % NaCl at 35 mC and do not utilize citrate, -glucitol (-sorbitol), i-myo-inositol or -mannitol as sole sources of carbon.…”

Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

“…Infections caused by rapidly growing NTM have been reported following cardiac bypass surgery [19][20][21][22][23] , peritoneal dialysis 24 and middle ear cleaning 25 . Individuals tend to be predisposed to NTM infection e.g.…”

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].…”

“…chelonae has been aetiologically implicated in several clinical syndromes which include not only organ-specific pathology but also disseminated disease [6]. Isolated cases are common [7][8][9][10][11][12][13][14] but outbreaks are not [15][16][17][18][19][20][21][22].…”