This investigation identified the use of contaminated gel as the common source causing an outbreak on a larger scale than had been recognised” Cheng et al (2016).
Background: Post-procedural 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.
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Methods: Investigation conducted at a 2200-bed teaching hospital in Taiwan including 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 (MLST) and pulsed-field gel electrophoresis (PFGE).
Results: We investigated 40 patients who developed post-procedure, soft tissue or bloodstream infections by M. massiliense (TPE101), during a 3-year period. 38 patients were identified at hospital A, one newborn and her mother were identified at hospital B (185 kilometers from hospital A). A case-control study identified the association of invasive procedures (adjusted odds ratio [aOR] 9.13) and ultrasonography (aOR 2.97) (both p<0.05) with acquiring the outbreak strain. Isolates from the cases and unopened bottles of ultrasound transmission gel were all ST48 and indistinguishable or closely related by PFGE. After replacement of contaminated gel, no new cases have been detected in the 18 months of follow-up.
Conclusions: This investigation identified the use of contaminated gel as the common source causing an outbreak on a larger scale than had been recognised. Our findings halted production by the manufacturer and prompted revision of hospital guidelines.
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. and Chen, Y-C. and Chang, S-C. (2016) Prolonged Post-procedural Outbreak of Mycobacterium massiliense Infections Associated with Ultrasound Transmission Gel. Clinical Microbiology and Infection. January 18th. [epub ahead of print].
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