Skip to main content Accessibility help
×
Home

A Cluster of Central Line–Associated Bloodstream Infections Due to Rapidly Growing Nontuberculous Mycobacteria in Patients with Hematologic Disorders at a Japanese Tertiary Care Center: An Outbreak Investigation and Review of the Literature

  • Yasuaki Tagashira (a1) (a2), Yasuji Kozai (a3), Hitomi Yamasa (a2), Masako Sakurada (a4), Tetsuya Kashiyama (a5) and Hitoshi Honda (a1) (a2)...

Abstract

BACKGROUND

Rapidly growing nontuberculous mycobacteria (RGM) are considered rare pathogens, causing central line–associated bloodstream infection. We identified an outbreak of central line–associated bloodstream infection due to RGM at a hematology-oncology ward during a 5-month period.

DESIGN

Outbreak investigation and literature review.

SETTING

A Japanese tertiary care center.

PATIENTS

Adults who were hospitalized at the hematology-oncology ward from October 15, 2011, through February 17, 2012.

RESULTS

A total of 5 patients with a bloodstream infection due to RGM (4 cases of Mycobacterium mucogenicum and 1 case of Mycobacterium canariasense infection) were identified; of these, 3 patients had acute myeloid leukemia, 1 had acute lymphocytic leukemia, and 1 had aplastic anemia. Four of the 5 patients received cord blood transplantation prior to developing the bloodstream infection. All central venous catheters in patients with a bloodstream infection were removed. These patients promptly defervesced after catheter removal and their care was successfully managed without antimicrobial therapy. Surveillance cultures from the environment and water detected M. mucogenicum and M. canariasense in the water supply of the hematology-oncology ward. The isolates from the bloodstream infection and water sources were identical on the basis of 16S-rRNA gene sequencing.

CONCLUSIONS

The source of RGM in the outbreak of bloodstream infections likely was the ward tap water supply. Awareness of catheter-related bloodstream infections due to nontuberculous mycobacteria should be emphasized, especially where immunocompromised patients are at risk. Also, using antimicrobials after catheter removal to treat central line–associated bloodstream infection due to RGM may not be necessary.

Infect Control Hosp Epidemiol 2015;36(1): 76–80

Copyright

Corresponding author

Address correspondence to Yasuaki Tagashira, MD, Division of Infectious Diseases, Tokyo Metropolitan Tama General Medical Center, 2-8-29, Musashidai, Fuchu-city, Tokyo, 183-8524, Japan (y.tagashira@gmail.com).

References

Hide All
1.Phillips, MS, von Reyn, CF. Nosocomial infections due to nontuberculous mycobacteria. Clin Infect Dis 2001;33:13631374.
2.Runyon, EH. Identification of mycobacterial pathogens utilizing colony characteristics. Am J Clin Path 1970;54:578586.
3.Runyon, EH. Anonymous mycobacteria in pulmonary disease. Med Clin N Amer 1959;43:273290.
4.Springer, B, Bottger, EC, Kirschner, P, Wallace, RJ Jr. Phylogeny of the Mycobacterium chelonae-like organism based on partial sequencing of the 16S rRNA gene and proposal of Mycobacterium mucogenicum sp. nov. Int J Syst Bacteriol 1995;45:262267.
5.Jimenez, MS, Campos-Herrero, MI, Garcia, D, Luquin, M, Herrera, L, Garcia, MJ. Mycobacterium canariasense sp. nov. Int J Syst Evol Microbiol 2004;54:17291734.
6.Campos-Herrero, MI, Garcia, D, Figuerola, A, Suarez, P, Campo, C, Garcia, MJ. Bacteremia caused by the novel species Mycobacterium canariasense. Eur J Clin Microbiol Infect Dis 2006;25:5860.
7.Glucksberg, H, Storb, R, Fefer, A, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974;18:295304.
8.Livni, G, Yaniv, I, Samra, Z, et al. Outbreak of Mycobacterium mucogenicum bacteraemia due to contaminated water supply in a paediatric haematology-oncology department. J Hosp Infect 2008;70:253258.
9.Ashraf, MS, Swinker, M, Augustino, KL, et al. Outbreak of Mycobacterium mucogenicum bloodstream infections among patients with sickle cell disease in an outpatient setting. Infect Control Hosp Epidemiol 2012;33:11321136.
10.Hawkins, C, Qi, C, Warren, J, Stosor, V. Catheter-related bloodstream infections caused by rapidly growing nontuberculous mycobacteria: a case series including rare species. Diagn Microbiol Infect Dis 2008;61:187191.
11.Cooksey, RC, Jhung, MA, Yakrus, MA, et al. Multiphasic approach reveals genetic diversity of environmental and patient isolates of Mycobacterium mucogenicum and Mycobacterium phocaicum associated with an outbreak of bacteremias at a Texas hospital. Appl Environ Microbiol 2008;74:24802487.
12.Kirschner, P, Springer, B, Vogel, U, et al. Genotypic identification of mycobacteria by nucleic acid sequence determination: report of a 2-year experience in a clinical laboratory. J Clin Microbiol 1993;31:28822889.
13.Kim, BJ, Lee, SH, Lyu, MA, et al. Identification of mycobacterial species by comparative sequence analysis of the RNA polymerase gene (rpoB). J Clin Microbiol 1999;37:17141720.
14.Blackwood, KS, He, C, Gunton, J, Turenne, CY, Wolfe, J, Kabani, AM. Evaluation of recA sequences for identification of Mycobacterium species. J Clin Microbiol 2000;38:28462852.
15.Telenti, A, Marchesi, F, Balz, M, Bally, F, Bottger, EC, Bodmer, T. Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol 1993;31:175178.
16.Roth, A, Reischl, U, Streubel, A, et al. Novel diagnostic algorithm for identification of mycobacteria using genus-specific amplification of the 16S-23S rRNA gene spacer and restriction endonucleases. J Clin Microbiol 2000;38:10941104.
17.Zhang, Y, Rajagopalan, M, Brown, BA, Wallace, RJ Jr.Randomly amplified polymorphic DNA PCR for comparison of Mycobacterium abscessus strains from nosocomial outbreaks. J Clin Microbiol 1997;35:31323139.
18.Kline, S, Cameron, S, Streifel, A, et al. An outbreak of bacteremias associated with Mycobacterium mucogenicum in a hospital water supply. Infect Control Hosp Epidemiol 2004;25:10421049.
19.Baird, SF, Taori, SK, Dave, J, Willocks, LJ, Roddie, H, Hanson, M. Cluster of non-tuberculous mycobacteraemia associated with water supply in a haemato-oncology unit. J Hosp Infect 2011;79:339343.
20.Shachor-Meyouhas, Y, Sprecher, H, Eluk, O, Ben-Barak, A, Kassis, I. An outbreak of Mycobacterium mucogenicum bacteremia in pediatric hematology-oncology patients. Pediatr Infect Dis J 2011;30:3032.
21.O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39(4 Suppl 1):S134.
22.Gaviria, JM, Garcia, PJ, Garrido, SM, Corey, L, Boeckh, M. Nontuberculous mycobacterial infections in hematopoietic stem cell transplant recipients: characteristics of respiratory and catheter-related infections. Biol Blood Marrow Transplant 2000;6:361369.
23.Roy, V, Weisdorf, D. Mycobacterial infections following bone marrow transplantation: a 20 year retrospective review. Bone Marrow Transplant 1997;19:467470.
24.Raad, II, Vartivarian, S, Khan, A, Bodey, GP. Catheter-related infections caused by the Mycobacterium fortuitum complex: 15 cases and review. Rev Infect Dis 1991;13:11201125.
25.Woo, PC, Tsoi, HW, Leung, KW, et al. Identification of Mycobacterium neoaurum isolated from a neutropenic patient with catheter-related bacteremia by 16S rRNA sequencing. J Clin Microbiol 2000;38:35153517.
26.Holland, DJ, Chen, SC, Chew, WW, Gilbert, GL. Mycobacterium neoaurum infection of a Hickman catheter in an immunosuppressed patient. Clin Infect Dis 1994;18:10021003.
27.Rodgers, GL, Mortensen, JE, Blecker-Shelly, D, Fisher, MC, Long, SS. Two case reports and review of vascular catheter-associated bacteremia caused by nontuberculous Mycobacterium species. Pediatr Infect Dis J 1996;15:260264.

A Cluster of Central Line–Associated Bloodstream Infections Due to Rapidly Growing Nontuberculous Mycobacteria in Patients with Hematologic Disorders at a Japanese Tertiary Care Center: An Outbreak Investigation and Review of the Literature

  • Yasuaki Tagashira (a1) (a2), Yasuji Kozai (a3), Hitomi Yamasa (a2), Masako Sakurada (a4), Tetsuya Kashiyama (a5) and Hitoshi Honda (a1) (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed