Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel
Journal
Clinical Microbiology and Infection
Journal Volume
22
Journal Issue
4
Pages
3820
Date Issued
2016
Author(s)
Huang Y.-C.
Tsai Y.-T.
Chen M.-L.
Liu Y.-C.
Chang C.-I.
Huang W.-C.
Abstract
Postprocedural infections by Mycobacterium abscessus complex are increasing worldwide, and the source and route of transmission are infrequently identified. Here the extension of a previous clustering of paediatric patients with surgical site infections due to a single strain of the subspecies M. massiliense is reported. The investigation was conducted at a 2200-bed teaching hospital in Taiwan and included microbial surveillance of the environment (water, air, equipment and supplies) and a case-control study. We performed molecular identification and typing of the isolates by a trilocus sequencing scheme, confirmed by multilocus sequencing typing and pulsed-field gel electrophoresis. We investigated 40 patients who developed postprocedure soft tissue or bloodstream infections by M. massiliense (TPE101) during a 3-year period. Thirty-eight patients were identified at hospital A, and one newborn and her mother were identified at hospital B (185 km from hospital A). A case-control study identified the association of invasive procedures (adjusted odds ratio, 9.13) and ultrasonography (adjusted odds ratio, 2.97) (both p <0.05) with acquiring the outbreak strain. Isolates from the cases and unopened bottles of ultrasound transmission gel were all of strain ST48 and indistinguishable or closely related by pulsed-field gel electrophoresis. After replacement of contaminated gel, no new cases were detected during 18 months' follow-up. This investigation identified the use of contaminated gel as the common source causing an outbreak on a larger scale than had been recognized. Our findings halted production by the manufacturer and prompted revision of hospital guidelines. ? 2016 European Society of Clinical Microbiology and Infectious Diseases.
Other Subjects
adolescent; adult; aged; Article; bloodstream infection; case control study; child; clinical article; controlled study; female; follow up; gel; human; infant; invasive procedure; male; middle aged; multilocus sequence typing; mycobacteriosis; Mycobacterium massiliense; Mycobacterium massiliense infection; newborn; priority journal; pulsed field gel electrophoresis; retrospective study; soft tissue infection; surgical infection; ultrasound transmission gel; adverse effects; atypical Mycobacterium; classification; drug contamination; echography; epidemic; genetics; genotype; isolation and purification; microbiology; Mycobacterium Infections, Nontuberculous; Surgical Wound Infection; Taiwan; teaching hospital; very elderly; Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Disease Outbreaks; Drug Contamination; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Hospitals, Teaching; Humans; Infant; Infant, Newborn; Male; Middle Aged; Multilocus Sequence Typing; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Retrospective Studies; Surgical Wound Infection; Taiwan; Ultrasonography
Publisher
Elsevier B.V.
Type
journal article