Nosocomial Outbreaks/Pseudo Outbreaks Caused by Nontuberculous Mycobacteria

Abstract

Nosocomial outbreaks and pseudo-outbreaks caused by the nontuberculous mycobacteria (NTM) have been recognized for more than 20 years and continue to be a problem. Most of these outbreaks have involved the rapidly growing mycobacterial species Mycobacterium fortuitum and M. abscessus. The reservoir for these outbreaks is generally municipal and (often separate) hospital water supplies. These mycobacterial species and others are incredibly hardy, able to grow in municipal and distilled water, thrive at temperatures of 45 degrees C or above (M. xenopi and M. avium complex), and resist the activity of organomercurials, chlorine, 2% concentrations of formaldehyde and alkaline glutaraldehyde, and other commonly used disinfectants. Disease outbreaks usually involve sternal wound infections, plastic surgery wound infections, or postinjection abscesses. Pseudo-outbreaks most commonly relate to contaminated bronchoscopes and endoscopic cleaning machines (M. abscessus) and contaminated hospital water supplies (M. xenopi). Knowledge of the reservoir of these species, their great survival capabilities within the hospital, and newer molecular techniques for strain comparison have helped control and more quickly identify current nosocomial outbreaks or pseudo-outbreaks caused by the NTM.

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.…”

Epidemic and sporadic cases of nontuberculous mycobacterial keratitis associated with laser in situ keratomileusis

“…Because NTM are ubiquitous in soil and water (including tap water), they may cause infection when surgical instruments or clinical devices are exposed to contaminated water, ice, or other solutions. 6 Ophthalmologists should be aware of these LASIK-associated NTM infections, particularly as they may have unique diagnostic and treatment features and the ability to cause severe morbidity in patients with previously good vision. 1 To decrease the risk of such infections, surgeons should ensure that non-sterile solutions are not introduced into surgical procedures.…”

Pesquisa de Micobactérias Ambientais em água de torneira, luvas e soluções utilizadas em procedimentos cirúrgicos no Hospital Universitário Getúlio Vargas - Manaus/AM

“…Desses, à água é dada a menor importância como uma possível fonte de contaminação nosocomial de micobacteriose. Entretanto nas águas tratadas e utilizadas em moradias, indústrias e hospitais, as referidas espécies são reconhecidas como uma importante fonte de micobactérias, e consideradas como o reservatório principal para a maioria de surtos e pseudo surtos nosocomiais (Wallace-Jr et al, 1998). Ambas as espécies não foram isoladas no presente trabalho, porém outras de igual importância em surtos como M. celatum, M. intracellulare e M. mucogenicum estão presentes nas águas de serventia do Hospital Universitário Getúlio Vargas.…”

“…Os mais prováveis agentes de contaminação micobacteriana, indutores de surtos de micobacteriose pós-cirúrgica, são a água de serventia hospitalar, matérias, soluções e instrumentos utilizados nos procedimentos cirúrgicos (Foz et al, 1978;Gremillion et al, 1983;Wallace-Jr et al, 1998;Sethi et al, 2001;Phillips;Von Reyn, 2001;Winthrop et al, 2002;Mackay et al, 2002). Nesse sentido e visando ações profiláticas, foi investigada, por métodos bacteriológicos e moleculares, a presença de micobactérias ambientais em águas, soluções e luvas cirúrgicas, utilizadas nas etapas de procedimentos cirúrgicos executados no Hospital Universitário Getúlio Vargas (HUGV), pertencente à Universidade Federal do Amazonas (UFAM), na cidade de Manaus/AM.…”