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Clusters of nontuberculous mycobacteria linked to water sources at three Veterans Affairs medical centers

Published online by Cambridge University Press:  11 December 2019

Gina Oda
Affiliation:
Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California
Mark A. Winters
Affiliation:
VHA Public Health Reference Laboratory, Palo Alto, California Division of Infectious Disease & Geographic Medicine, Stanford University School of Medicine, Stanford, California
Susan M. Pacheco
Affiliation:
Edward Hines Jr. VA Medical Center, Chicago, Illinois Loyola University Medical Center, Maywood, Illinois
Monica K. Sikka
Affiliation:
Jesse Brown VA Medical Center, Chicago, Illinois University of Illinois, Chicago, Illinois
Susan C. Bleasdale
Affiliation:
Jesse Brown VA Medical Center, Chicago, Illinois University of Illinois, Chicago, Illinois
Bruce Dunn
Affiliation:
Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin Medical College of Wisconsin, Milwaukee, Wisconsin
Erin Boswell
Affiliation:
Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana Tulane University School of Medicine, New Orleans, Louisiana
Benjamin Winters
Affiliation:
VHA Public Health Reference Laboratory, Palo Alto, California
Amelia Bumsted
Affiliation:
Edward Hines Jr. VA Medical Center, Chicago, Illinois
Jennifer Frisch
Affiliation:
Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana
Mark Holodniy
Affiliation:
Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, California VHA Public Health Reference Laboratory, Palo Alto, California Division of Infectious Disease & Geographic Medicine, Stanford University School of Medicine, Stanford, California
Corresponding
E-mail address:

Abstract

Objective:

To characterize nontuberculous mycobacteria (NTM) associated with case clusters at 3 medical facilities.

Design:

Retrospective cohort study using molecular typing of patient and water isolates.

Setting:

Veterans Affairs Medical Centers (VAMCs).

Methods:

Isolation and identification of NTM from clinical and water samples using culture, MALDI-TOF, and gene population sequencing to determine species and genetic relatedness. Clinical data were abstracted from electronic health records.

Results:

An identical strain of Mycobacterium conceptionense was isolated from 41 patients at VA Medical Centers (VAMCs A, B, and D), and from VAMC A’s ICU ice machine. Isolates were initially identified as other NTM species within the M. fortuitum clade. Sequencing analyses revealed that they were identical M. conceptionense strains. Overall, 7 patients (17%) met the criteria for pulmonary or nonpulmonary infection with NTM, and 13 of 41 (32%) were treated with effective antimicrobials regardless of infection or colonization status. Separately, a M. mucogenicum patient strain from VAMC A matched a strain isolated from a VAMC B ICU ice machine. VAMC C, in a different state, had a 4-patient cluster with Mycobacterium porcinum. Strains were identical to those isolated from sink-water samples at this facility.

Conclusion:

NTM from hospital water systems are found in hospitalized patients, often during workup for other infections, making attribution of NTM infection problematic. Variable NTM identification methods and changing taxonomy create challenges for epidemiologic investigation and linkage to environmental sources.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part (poster 648) at IDWeek 2017 on October 5, 2017, in San Diego, California.

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