Mycobacteroides abscessus outbreak and mitigation in a cardiothoracic transplant population: the problem with tap water

S. N. Rathod*, R. T. Weber, A. A. Salim, S. D. Tanna, V. Stosor, M. Malczynski, A. O'Boye, K. Hoke, J. Landon, S. McCarthy, C. Qi, M. P. Angarone, M. G. Ison, J. L. Williams, T. R. Zembower, M. K. Bolon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hospital outbreaks caused by Mycobacteroides abscessus complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population. Aim: To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated M. abscessus complex cases in an inpatient cardiothoracic transplant population. Methods: We extracted clinical characteristics from patients with M. abscessus pre-outbreak (March 2018 to December 2020) and during the outbreak (January 2021 to June 2022) from the electronic medical record. A multi-disciplinary team conducted the outbreak investigation and devised a mitigation strategy to implement at our institution. Findings: The baseline incidence of healthcare-associated M. abscessus was 0.11 cases per 10,000 patient-days; this increased to 0.24 cases per 10,000 patient-days during the outbreak. There were 1/9 (11%) cardiothoracic transplant patients in the pre-outbreak group compared with 7/12 (58%) during the outbreak, and respiratory specimen types compromised 6/9 (67%) of M. abscessus results in the pre-outbreak group compared with 10/12 (83%) during the outbreak. Among the clinical care activities involving water, a variety of water sources were utilized, including filtered and tap water. The incidence of healthcare-associated M. abscessus subsequently decreased to 0.06 cases per 10,000 patient-days after implementing an outbreak-mitigation strategy of sterile water precautions. Conclusions: Robust educational efforts from a multi-disciplinary team on eliminating exposure to tap water were effective measures to reduce healthcare-associated M. abscessus incidence at our institution. Non-tuberculous mycobacteria infection surveillance, targeted education, and water mitigation strategies may be beneficial preventative strategies for other lung transplant centres facing similar issues.

Original languageEnglish (US)
Pages (from-to)150-157
Number of pages8
JournalJournal of Hospital Infection
Volume155
DOIs
StatePublished - Jan 2025

Keywords

  • Cardiothoracic transplant
  • Heart transplant
  • Lung transplant
  • Mycobacteroides abscessus
  • Non-tuberculous mycobacteria
  • Tap water

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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