三起肺外脓肿分枝杆菌感染病例与维护良好的水基加热器-冷却器装置有关

Jessica L. Seidelman, Arthur W. Baker, Sarah S. Lewis, Bobby G. Warren, Aaron Barrett, Amanda Graves, Carly King, Bonnie Taylor, Jill Engel, Desiree Bonnadonna, Carmelo Milano, Richard J. Wallace, Matthew Stiegel, Deverick J. Anderson, Becky A. Smith
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引用次数: 0

摘要

背景:各种水基加热器-冷却器(HCD)都与非结核分枝杆菌疫情有牵连。方法:研究人员召集了一个多学科小组,开展了一项全面调查,以确定医疗机构中脓毒症分枝杆菌的潜在来源。研究人员审查了患者护理过程中是否遵守避免使用自来水的规定,以及 HCD 的清洁、消毒和维护方法。采集了相关的环境样本。使用多焦点序列分型和脉冲场凝胶电泳对患者和环境中的脓毒症梭菌分离物进行比较。进行了烟雾测试,以评估 HCD 使用过程中产生和扩散气溶胶的可能性。结果:病例患者的临床表现和流行病学数据支持术中感染。从患者使用的 HCD 中分离出了脓肿霉菌,与患者分离物的分子比较显示了克隆性。烟雾测试模拟了在设备操作过程中脓肿霉菌从 HCD 中气溶胶化。结论:尽管 HCD 的清洁和消毒策略超出了制造商的使用说明,但 HCD 还是被脓毒性蘑菇菌定植并最终传染给了 3 名患者。为防止水基 HCD 的 NTM 传播,需要对设计进行修改,以便在设备运行期间更好地控制气溶胶或过滤废气。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A cluster of three extrapulmonary Mycobacterium abscessus infections linked to well-maintained water-based heater-cooler devices
Background:

Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.

Methods:

Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.

Results:

Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.

Conclusions:

Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.

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