Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice.
Seventeen cases of otitis media caused by Mycobacterium chelonae were detected among patients seen at a single ear-nose-and-throat (ENT) office (Office A) in Louisiana between May 5 and September 15, 1987. All the patients had a tympanotomy tube or tubes in place or had one or more tympanic-membrane perforations, with chronic otorrhea that was unresponsive to standard therapy with antimicrobial agents. Middle-ear exploration in six patients revealed abundant granulation tissue; multiple granulomas and acid-fast bacilli were demonstrated on a section of tissue from one patient with a nonhealing mastoidectomy incision. Thirteen of the 14 ear isolates obtained from patients seen in Office A had the same unusual pattern of high-level resistance to aminoglycosides. M. chelonae and other nontuberculous mycobacteria were recovered from several sources of water in Office A, as well as in another ENT office (Office B) in a neighboring city that was visited by the index patient. Only one additional case was detected in Office B during the same period. Otologic instruments in Office A were cleaned in an ultrasonic bath with tap water and a liquid detergent; the contents of the bath were changed only once weekly. Instruments in Office B were placed in boiling water between patient examinations. This outbreak establishes M. chelonae as an agent of otitis media and underscores the need for high-level disinfection or sterilization of ENT instruments between examinations to prevent the transmission of this organism to patients in the office setting.
Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
P W
PW
Lowry
W R
WR
Jarvis
A D
AD
Oberle
L A
LA
Bland
R
R
Silberman
J A
JA
Bocchini
H D
HD
Dean
J M
JM
Swenson
R J
RJ
Wallace
D004196:Disease Outbreaks; D004866:Equipment Contamination; D006801:Humans; D007223:Infant; D008145:Louisiana; D008297:Male; D009164:Mycobacterium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000635:transmission; D010033:Otitis Media / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000635:transmission; D010036:Otolaryngology / Q000295:instrumentation*; D012307:Risk Factors; D014871:Water Microbiology