Prolonged postprocedural outbreak of Mycobacterium massiliense infections associated with ultrasound transmission gel. (April 2016)

• Record Type: Journal Article
• Authors: Cheng, A.; Sheng, W.-H.; Huang, Y.-C.; Sun, H.-Y.; Tsai, Y.-T.; Chen, M.-L.; Liu, Y.-C.; Chuang, Y.-C.; Huang, S.-C.; Chang, C.-I.; Chang, L.-Y.; Huang, W.-C.; Hsueh, P.-R.; Hung, C.-C.; Chen, Y.-C.; Chang, S.-C.
• Is Part Of: Clinical microbiology and infection. Volume 22:Number 4(2016)
• Page Start: 382.e1
• Page End: 382.e11
• Publication Date: 2016-04
• Subjects: Mycobacterium abscessus -- Mycobacterium massiliense -- outbreak -- skin and soft tissue infections -- ultrasonography gel; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2015.11.021
• Languages: English
• ISSNs: 1198-743X

Abstract

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.