title: An outbreak of bacteremias associated with Mycobacterium mucogenicum in a hospital water supply.
abstract: OBJECTIVE
  To investigate and determine the cause of an outbreak of Mycobacterium mucogenicum bacteremias in bone marrow transplant (BMT) and oncology patients.
  
  
  METHODS
  Case-control study and culturing of hospital water sources. Isolates were typed using molecular methods.
  
  
  METHODS
  University-affiliated, tertiary-care medical center.
  
  
  METHODS
  Case-patients were adult and pediatric BMT patients or hematopoietic stem cell transplant (BMT) (n = 5) and oncology (n = 1) patients who were diagnosed as having M. mucogenicum bacteremia during the study period of August through November 1998. Two control-patients were selected for each case-patient matched by age, time of hospitalization, inpatient unit, and type of patient (BMT or oncology).
  
  
  RESULTS
  There were no significant differences between case-patients and control-patients regarding intravenous products received or procedures performed, frequency of bathing, neutropenia, or steroid use. Nontuberculous mycobacteria were isolated from several water sources at the medical center including tap water from sinks and showerheads, the hospital hot water source, and the city water supply to the hospital. Analysis by multilocus enzyme electrophoresis and randomly amplified polymorphic DNA showed a match between one patient's blood isolate and an isolate from shower water from that patient's prior hospital room.
  
  
  CONCLUSIONS
  The cause of the outbreak seemed to be water contamination of central venous catheters (CVCs) during bathing. A recommendation in early 2001 that CVCs be protected from water during bathing was followed by no M. mucogenicum bacteremias during the second half of 2001, only one in 2002, and none at all during 2003.
authors.affiliation: Infection Control Department, Fairview-University Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Kline
authors.forename: Sarah
authors.initials: S
authors.lastname: Cameron
authors.forename: Andrew
authors.initials: A
authors.lastname: Streifel
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Yakrus
authors.forename: Frank
authors.initials: F
authors.lastname: Kairis
authors.forename: Keith
authors.initials: K
authors.lastname: Peacock
authors.forename: John
authors.initials: J
authors.lastname: Besser
authors.forename: Robert C
authors.initials: RC
authors.lastname: Cooksey
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D016026:Bone Marrow Transplantation; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D003428:Cross Infection / Q000209:etiology; D006785:Hospitals, University; D006801:Humans; D009161:Mycobacterium / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000150:complications*; D009369:Neoplasms / Q000150:complications; D012307:Risk Factors; D014881:Water Supply