The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Outbreak Investigation of Mycobacterium abscessus Infections

Authors: Katie Gravagna, MSc, Lauren DiBiase, MS, CIC, Lisa Teal, BSN, RN, Sharon Thompson, MT, Cynthia Culbreth, BSN, RN, RN-BC, Tara Sotak, RN, Jessica Wiley, RN, Greg Griffin, BS, David J. Weber, MD, MPH, Emily Sickbert-Bennett, PhD, MS, CIC

Abstract

Objective: Nontuberculous mycobacteria are ubiquitous in the environment and difficult to eliminate from contaminated water sources. The prevalence of Mycobacterium abscessus is particularly high in the southeastern United States. M. abscessus infections have become a particularly concerning source of outbreaks in healthcare settings, and can lead to substantial patient morbidity and mortality. We summarize a 2019-2023 epidemiologic outbreak investigation of hospitalized patients with positive M. abscessus cultures and subsequent interventions.

Methods: We investigated an M. abscessus outbreak in a large academic hospital from September 2019 to August 2023. Case reviews of positive cultures and/or those with heater-cooler or extracorporeal membrane oxygenation exposure were undertaken along with environmental sampling of suspected sources and infection prevention
compliance monitoring. Outbreak interventions, including more frequent heater-cooler disinfection periods, were put in place and evaluated over time.

Results: The majority of the cases were suspected to have been community-associated, and the patients were of older ages, had multiple comorbidities, and prolonged hospital stays. Patient care items frequently were found to be stored near patient sinks. Persistent contamination of heater-cooler machines with M. abscessus was seen even after adopting an enhanced disinfection protocol.

Conclusions: This M. abscessus outbreak demonstrated the difficulties in eliminating M. abscessus contamination from heater-cooler units and the complexities of both outbreak source identification and interventions. Future work is needed for faster nontuberculous mycobacteria outbreak detection and more efficient outbreak management tools.
Posted in: Infectious Disease156

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