title: Forty years of disinfectant failure: outbreak of postinjection Mycobacterium abscessus infection caused by contamination of benzalkonium chloride.
abstract: Benzalkonium chloride (BC) continues to be used as an antiseptic and contributes to serious outbreaks of disease. In July 1999, 6 postinjection joint infections caused by Mycobacterium abscessus were reported to the Texas Department of Health (Austin). We investigated this outbreak and identified 12 case patients who had been seen by the same physician and who had received an intra-articular or periarticular steroid injection during the period of 1 April through 31 July 1999. M. abscessus was cultured from either joint fluid or periarticular soft-tissue specimens obtained from 10 patients. We cultured environmental samples, and we compared isolates recovered from case patients with environmental isolates by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). Four environmental samples containing diluted BC yielded M. abscessus. Clinical and environmental strains of M. abscessus were indistinguishable by RAPD-PCR. The case patients' strain was resistant to BC. The use of BC as an antiseptic should be discontinued.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. tit2@cdc.gov
authors.forename: Tejpratap S P
authors.initials: TS
authors.lastname: Tiwari
authors.forename: Beverly
authors.initials: B
authors.lastname: Ray
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Jost
authors.forename: Minaxi K
authors.initials: MK
authors.lastname: Rathod
authors.forename: Yansheng
authors.initials: Y
authors.lastname: Zhang
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Brown-Elliott
authors.forename: Kate
authors.initials: K
authors.lastname: Hendricks
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001548:Benzalkonium Compounds; D004196:Disease Outbreaks; D004340:Drug Contamination; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000453:epidemiology*; D019105:Random Amplified Polymorphic DNA Technique; D013781:Texas / Q000453:epidemiology
chemical_list: D001548:Benzalkonium Compounds