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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

Published online by Cambridge University Press:  05 January 2015

Yasuaki Tagashira ,
Yasuji Kozai ,
Hitomi Yamasa ,
Masako Sakurada ,
Tetsuya Kashiyama  and
Hitoshi Honda
Yasuaki Tagashira*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan
Yasuji Kozai
Affiliation:
Department of Hematology, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan
Hitomi Yamasa
Affiliation:
Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan
Masako Sakurada
Affiliation:
Department of Microbiology, Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan
Tetsuya Kashiyama
Affiliation:
Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
Hitoshi Honda
Affiliation:
Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan Department of Infection Prevention, Tokyo Metropolitan Tama General Medical Center, Fuchu, Tokyo, Japan
*
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).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 76 - 80
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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