title: Molecular epidemiology of Mycobacterium abscessus infections in a subtropical chronic ventilatory setting.
abstract: The aim of this study was to investigate the high level of pulmonary Mycobacterium abscessus infections and implement a surveillance programme among 43 ventilator-dependent patients, 15 with pulmonary M. abscessus infections, in a hospital long-term respiratory care ward (RCW) in central Taiwan. M. abscessus isolates were obtained from 35 patients in the RCW of hospital A, 6 patients in the RCWs of another three hospitals (B, C and D), and from 4 water sources in two of the hospitals (A and B). Strains were characterized by methods including hsp65 PCR-RFLP and PFGE. The patients were followed-up by chest X-ray for 1 year. All clinical isolates were type I and II, and belonged to ten distinct clusters of PFGE patterns. Five clinical strains in two hospitals belonged to a single cluster, whilst four clinical strains in the other two hospitals belonged to a single unique cluster. The strains from hospital A fell into nine clusters and were distinct from the strains isolated from the water supply. Patients infected with type I strains showed a significantly more rapid progression of disease. The number of different strains involved suggested either that there had been a polyclonal outbreak or that a high level of endemic infections was present in the RCW of hospital A. This and the lack of homology between the clinical and environmental isolates from hospital A raised the possibility that pulmonary M. abscessus infections may have been spread by the movement of patients between RCWs, a routine practice in Taiwan's integrated delivery system.
authors.affiliation: Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Wei-Chang
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Central Region Laboratory, Center of Research and Diagnostics, Centers for Disease Control, Taichung, Taiwan, ROC.
authors.forename: Chien-Shun
authors.initials: CS
authors.lastname: Chiou
authors.affiliation: Institute of Molecular Biology, National Chung Hsing University, Taichung, Taiwan, ROC.
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Institute of Respiratory Therapy, China Medical University, Taichung, Taiwan, ROC.|Institute of Molecular Biology, National Chung Hsing University, Taichung, Taiwan, ROC.|Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Gwan-Han
authors.initials: GH
authors.lastname: Shen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009161:Mycobacterium / Q000145:classification* / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000453:epidemiology* / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D012150:Polymorphism, Restriction Fragment Length; D013902:Radiography, Thoracic; D013624:Taiwan; D014871:Water Microbiology
chemical_list: D004269:DNA, Bacterial