Molecular Epidemiologic Investigation of <i>Mycobacterium intracellulare</i> Subspecies <i>chimaera</i> Lung Infections at an Adult Cystic Fibrosis Program

Gross, Jane E.; Tenebäck, Charlotte C.; Sweet, Julie G.; Caceres, Silvia M.; Poch, Katie R.; Hasan, Nabeeh A.; Fan, Jia; Epperson, L. Elaine; Lipner, Ettie M.; Vang, Charmie; Honda, Jennifer R.; Strand, Matthew; Moura, Vinicius Calado Nogueira de; Daley, Charles L.; Strong, Michael; Davidson, Rebecca M.; Nick, Jerry A.

doi:10.1513/annalsats.202209-779oc

Cited by 8 publications

(27 citation statements)

References 58 publications

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“…Phylogenetic trees will be created using longitudinally sequenced isolates from each pwCF and cluster network analysis performed as described [ 29 , 31 ]. Combined genetic plots will be created, pan genome analyzed, and pairwise accessory genome comparisons made [ 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…The HALT NTM Toolkit will analyze date and location data to identify possible acquisition and/or transmission events in the healthcare setting of subjects determined to fall within a cluster based on WGS and phylogenetic analysis [ 10 , 11 , 28 ]. Utilizing the HALT NTM Toolkit, demographic, patient location, microbiological data, and details regarding Center infection prevention and control (IP&C) practices will be collected from the electronic health record (EHR), then assembled and managed using REDCap® electronic data capture tools hosted at NJH [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

“…Healthcare data will be used to identify opportunities for transmission events between pwCF infected by clustered NTM isolates based on WGS and phylogenetic analysis. Timeline overlap analysis will be performed [ 10 , 11 ]. In all participating sites, dust and water biofilm healthcare environmental samples from the clinic, hospital, and research settings will be internally collected at the beginning of the study and every six months over a 2-year collection period.…”

Section: Methodsmentioning

confidence: 99%

“…Environmental samples will be mailed to NJH for environmental culture for NTM. If NTM is recovered, isolates will be banked, DNA extracted, WGS performed, and phylogenetic analysis completed [ 10 , 11 ]. If multiple NTM species or subspecies are recovered from a single environmental biofilm sample, all unique isolates of NTM species or subspecies will be analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…As a first step towards understanding NTM outbreaks among pwCF, the H ealthcare- a ssociated l inks in t ransmission of NTM (HALT NTM, NCT04024423) study developed an evidence-based epidemiologic investigation toolkit, linked with environmental sampling, watershed analysis, and integrated pan genomic analysis, to standardize investigations of potential healthcare-associated NTM outbreaks within CF Care Centers [ 28 ]. The HALT NTM Toolkit tests NTM transmission with whole genome sequencing (WGS) to genetically-match isolates between patients and/or environment with supportive evidence of epidemiologic exposure for potential cross-infection [ 10 , 11 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Prospective healthcare-associated links in transmission of nontuberculous mycobacteria among people with cystic fibrosis (pHALT NTM) study: Rationale and study design

Gross,

Caceres,

Poch

et al. 2023

PLoS ONE

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Background Healthcare-associated acquisition and transmission of nontuberculous mycobacteria (NTM) among people with cystic fibrosis (pwCF) has been described, and remains a concern for both patients and providers. This report describes the design of a prospective observational study utilizing the standardized epidemiologic investigation toolkit for healthcare-associated links in transmission of NTM among pwCF. Methods This is a parallel multi-site study of pwCF who have infections with respiratory NTM isolates and receive healthcare within a common CF Care Center. Participants have a history of one or more NTM positive airway cultures and have been identified as having NTM infections suggestive of a possible outbreak within a single Center, based on NTM isolate genomic analysis. Participants are enrolled in the study over a 3-year period. Primary endpoints are identification of shared healthcare-associated source(s) among pwCF in a Center, identification of healthcare environmental dust and water biofilm NTM isolates that are genetically highly-related to respiratory isolates, and identification of common home of residence watersheds among pwCF infected with clustered isolates. Secondary endpoints include characterization of healthcare-associated transmission and/or acquisition modes and settings as well as description of incidence and prevalence of healthcare-associated environmental NTM species/subspecies by geographical region. Discussion We hypothesize that genetically highly-related isolates of NTM among pwCF cared for at the same Center may arise from healthcare sources including patient-to-patient transmission and/or acquisition from health-care environmental dust and/or water biofilms. This study design utilizes a published, standardized, evidence-based epidemiologic toolkit to facilitate confidential, independent healthcare-associated NTM outbreak investigations within CF Care Centers. This study will facilitate real-time, rapid detection and mitigation of healthcare-associated NTM outbreaks to reduce NTM risk, inform infection prevention and control guidelines, and characterize the prevalence and origin of NTM outbreaks from healthcare-associated patient-to-patient transmission and/or environmental acquisition. This study will systematically characterize human disease causing NTM isolates from serial collection of healthcare environmental dust and water biofilms and define the most common healthcare environmental sources harboring NTM biofilms. Trial registration ClinicalTrials.gov NCT05686837.

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