Outbreak of <i>Mycobacterium mucogenicum</i> Bloodstream Infections among Patients with Sickle Cell Disease in an Outpatient Setting

Ashraf, Muhammad Salman; Swinker, Marian; Augustino, Kerri L.; Nobles, Delores L.; Knupp, Charles; Liles, Darla; Christie, John D.; Ramsey, Keith M.

doi:10.1086/668021

Cited by 21 publications

(13 citation statements)

References 18 publications

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“…Moreover, the result of the environment/water culture and type matching of isolates from the blood cultures with isolates from the environmental/water cultures indicated that the origin of these organisms was the tap water supply. As with previous instances, 8,9,19 we considered the portal of entry for both of these organisms into the bloodstream in this outbreak was likely to be the submersion of CVC during bathing, showering, or toileting. Enhancing the CVC dressing prior to bathing or showering is crucial.…”

Section: Discussionmentioning

confidence: 90%

“…5,6 Although the incidence of CLABSI due to RGM, especially M. mucogenicum, in hematopoietic stem cell transplant recipients or patients on intense immunosuppressive agents, appears to be low, 6 outbreaks of bloodstream infections among such patients have been reported between 2004 and 2012 (although the outbreak reported in 2004 actually occurred in 1998; Table 2). 8,9,11,[18][19][20] In this outbreak, 4 of 5 patients received dressing changes at the catheter site owing to submersion of the catheter during showering. Moreover, the result of the environment/water culture and type matching of isolates from the blood cultures with isolates from the environmental/water cultures indicated that the origin of these organisms was the tap water supply.…”

Section: Discussionmentioning

confidence: 99%

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A Cluster of Central Line–Associated Bloodstream Infections Due to Rapidly Growing Nontuberculous Mycobacteria in Patients with Hematologic Disorders at a Japanese Tertiary Care Center: An Outbreak Investigation and Review of the Literature

Tagashira

Kozai

Yamasa

et al. 2015

Infect. Control Hosp. Epidemiol.

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BACKGROUND Rapidly growing nontuberculous mycobacteria (RGM) are considered rare pathogens, causing central line-associated bloodstream infection. We identified an outbreak of central line-associated bloodstream infection due to RGM at a hematology-oncology ward during a 5-month period. DESIGN Outbreak investigation and literature review. SETTING A Japanese tertiary care center. PATIENTS Adults who were hospitalized at the hematology-oncology ward from October 15, 2011, through February 17, 2012. RESULTS A total of 5 patients with a bloodstream infection due to RGM (4 cases of Mycobacterium mucogenicum and 1 case of Mycobacterium canariasense infection) were identified; of these, 3 patients had acute myeloid leukemia, 1 had acute lymphocytic leukemia, and 1 had aplastic anemia. Four of the 5 patients received cord blood transplantation prior to developing the bloodstream infection. All central venous catheters in patients with a bloodstream infection were removed. These patients promptly defervesced after catheter removal and their care was successfully managed without antimicrobial therapy. Surveillance cultures from the environment and water detected M. mucogenicum and M. canariasense in the water supply of the hematology-oncology ward. The isolates from the bloodstream infection and water sources were identical on the basis of 16S-rRNA gene sequencing. CONCLUSIONS The source of RGM in the outbreak of bloodstream infections likely was the ward tap water supply. Awareness of catheter-related bloodstream infections due to nontuberculous mycobacteria should be emphasized, especially where immunocompromised patients are at risk. Also, using antimicrobials after catheter removal to treat central line-associated bloodstream infection due to RGM may not be necessary. Infect Control Hosp Epidemiol 2015;36(1): 76-80.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

A Cluster of Central Line–Associated Bloodstream Infections Due to Rapidly Growing Nontuberculous Mycobacteria in Patients with Hematologic Disorders at a Japanese Tertiary Care Center: An Outbreak Investigation and Review of the Literature

Tagashira

Kozai

Yamasa

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Higher prevalence rates were found in patients in this region with sickle cell disease [ 6 ]. Finally, an outbreak study of confirmed Mycobacterium mucogenicum bloodstream infections indicated that the four infected sickle cell disease patients had iron overload [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Only a modest number of mycobacterial infections have been reported in sickle cell disease. Those patients however were otherwise immunocompentent which raises the query of an alternative susceptibility in this patient population [ 5 – 8 ]. While sickle cell disease patients are known to be vulnerable to infections, there lacks explanation for susceptibility to mycobacterial organisms.…”

Section: Introductionmentioning

confidence: 99%

Mycobacterium aviumComplex Infection in a Patient with Sickle Cell Disease and Severe Iron Overload

Shemisa

Jafferjee

Thomas

et al. 2014

Case Reports in Infectious Diseases

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A 34-year-old female with sickle cell anemia (hemoglobin SS disease) and severe iron overload presented to our institution with the subacute presentation of recurrent pain crisis, fever of unknown origin, pancytopenia, and weight loss. A CT scan demonstrated both lung and liver nodules concerning for granulomatous disease. Subsequent biopsies of the liver and bone marrow confirmed the presence of noncaseating granulomas and blood cultures isolated Mycobacterium avium complex MAC. Disseminated MAC is considered an opportunistic infection typically diagnosed in the immunocompromised and rarely in immunocompetent patients. An appreciable number of mycobacterial infection cases have been reported in sickle cell disease patients without immune dysfunction. It has been reported that iron overload is known to increase the risk for mycobacterial infection in vitro and in vivo studies. While iron overload is primarily known to cause end organ dysfunction, the clinical relationship with sickle cell disease and disseminated MAC infection has not been reported. Clinical iron overload is a common condition diagnosed in the sub-Saharan African population. High dietary iron, genetic defects in iron trafficking, as well as hemoglobinopathy are believed to be the etiologies for iron overload in this region. Patients with iron overload in this region were 17-fold more likely to die from Mycobacterium tuberculosis. Both experimental and clinical evidence suggest a possible link to iron overload and mycobacterial infections; however larger observational studies are necessary to determine true causality.

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“…Because the organisms occur frequently in hospital tap water [67–70], many true outbreaks and several pseudo-outbreaks with NTM have been reported. Hospital-associated outbreaks and sporadic cases have included central line infections, sternal wound infections, cosmetic surgery-associated soft tissue infections, and bloodstream infections related to dialysis [71–80]. Most reported outbreaks involved exposure of invasive devices or nonintact skin to tap water.…”

Section: Mycobacteriamentioning

confidence: 99%

The role of water in healthcare-associated infections

Decker

Palmore

2013

Current Opinion in Infectious Diseases

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Purpose of review The aim is to discuss the epidemiology of infections that arise from contaminated water in healthcare settings, including Legionnaire’s disease, other Gram-negative pathogens, nontuberculous mycobacteria, and fungi. Recent findings Legionella can colonize a hospital water system and infect patients despite use of preventive disinfectants. Evidence-based measures are available for secondary prevention. Vulnerable patients can develop care-associated infections with waterborne organisms that are transmitted by colonization of plumbing systems, including sinks and their fixtures. Room humidifiers and decorative fountains have been implicated in serious outbreaks, and pose unwarranted risks in healthcare settings. Summary Design of hospital plumbing must be purposeful and thoughtful to avoid the features that foster growth and dissemination of Legionella and other pathogens. Exposure of patients who have central venous catheters and other invasive devices to tap water poses a risk for infection with waterborne pathogens. Healthcare facilities must conduct aggressive clinical surveillance for Legionnaire’s disease and other waterborne infections in order to detect and remediate an outbreak promptly. Hand hygiene is the most important measure to prevent transmission of other Gram-negative waterborne pathogens in the healthcare setting.

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Outbreak of Mycobacterium mucogenicum Bloodstream Infections among Patients with Sickle Cell Disease in an Outpatient Setting

Abstract: The source of the M. mucogenicum bacteremia outbreak was identified by genotyping analysis as the clinic tap water supply. The preparation of intravenous medications near the sink was likely an important factor in transmission, along with the presence of a faucet aerator.

Cited by 21 publications

References 18 publications

A Cluster of Central Line–Associated Bloodstream Infections Due to Rapidly Growing Nontuberculous Mycobacteria in Patients with Hematologic Disorders at a Japanese Tertiary Care Center: An Outbreak Investigation and Review of the Literature

A Cluster of Central Line–Associated Bloodstream Infections Due to Rapidly Growing Nontuberculous Mycobacteria in Patients with Hematologic Disorders at a Japanese Tertiary Care Center: An Outbreak Investigation and Review of the Literature

Mycobacterium aviumComplex Infection in a Patient with Sickle Cell Disease and Severe Iron Overload

The role of water in healthcare-associated infections

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