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To investigate the cause(s) of an increased incidence of clinical cultures growing Mycobacterium abscessus at a hospital in Florida.
University-affiliated, tertiary-care hospital.
A site visit was done during the first week of September 2006. We reviewed the medical records of patients from whom M. abscessus was recovered during the period from January 1, 2003, through June 30, 2006. We collected environmental samples from various sites and evaluated specimen processing procedures in the microbiology laboratory. Isolates of M. abscessus recovered from the environment and from 12 randomly selected patients who sought medical care in 2006 were compared by pulsed-field gel electrophoresis (PFGE). Follow-up case surveillance was continued through March 31, 2007.
Specimens from 143 patients obtained from various anatomical sites grew M. abscessus on culture in 2005-2006, compared with specimens from 21 patients in 2003-2004. The 12 isolates from patients that were selected for molecular typing had indistinguishable PFGE patterns. Observations revealed no major breaches in the processing of mycobacterial specimens in the laboratory. Isolates grew only after prolonged incubation (mean ± SD, 45 ± 15 days) in test tubes containing diagonally oriented Middlebrook and Cohn 7H10 agar or Lowenstein-Jensen medium. Environmental samples obtained from the inside of the specimen incubator grew M. abscessus on culture. A test tube containing diagonally oriented, uninoculated Middlebrook and Cohn 7H10 agar that was incubated in the same incubator as clinical specimens grew M. abscessus with a PFGE pattern that matched the pattern of the patient isolates. Cases of M. abscessus infection decreased to baseline after the hospital changed suppliers of mycobacterial media and cleaned the incubator.
Although the source was never confirmed, our investigation suggests that this was a pseudo-outbreak of M. abscessus infection that resulted from contamination of mycobacterial cultures during incubation. Our findings emphasize the need for guidance on the disinfection of specimen incubators.
William Knudson, Department of Agricultural Economics Michigan State University Agriculture Hall East Lansing, MI 48824 USA,
H. Christopher Peterson, Consumer-Responsive Agriculture Department of Agricultural Economics Michigan State University Agriculture Hall East Lansing, MI 48824 USA
Fish and seafood products are a significant part of the global agrifood sector. Fishery products are an important source of protein, especially for low-income food-deficit countries (LIFDCs) (FAO 2003a). Furthermore, world trade in fishery products continues to increase. Much of this trade is north–south, providing an important source of foreign exchange for low-income countries.
Several developing trends will affect the global fishery industry. Though capture fisheries (using fishing techniques to harvest wild fish and seafood products) remain responsible for the majority of fish and seafood product output, aquaculture is a large and growing part of the market. One of the factors contributing to the growth of aquaculture is the growth of supermarkets throughout the world. These markets require a standard product and a stable supply. Another factor affecting the seafood industry is the growth of eating away from home. In the United States, more than half the seafood eaten is consumed in restaurants, and restaurants also depend on a consistent product and a stable supply (Mintel 2002). Aquaculture is well suited to meet these requirements.
Because it appears unlikely that additional output from capture fisheries is possible, the potential for increased international trade in aquaculture products is great provided that the threats facing aquaculture can be addressed. As the aquaculture industry matures, it is increasingly taking on the same characteristics as terrestrial agriculture, with the attendant subsidies and potential trade restrictions designed to protect domestic producers. This situation presents a potential threat to increased international trade.
To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.
Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).
A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).
Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.