title: An outbreak of Mycobacterium abscessus infection in a Pediatric Intensive Care Unit in Kuwait.
abstract: BACKGROUND
  Mycobacterium abscessus has been associated with respiratory tract infections, localized skin and soft tissue infections and sepsis. However, outbreaks of M. abscessus are rare.
  
  
  OBJECTIVE
  to report an outbreak of M. abscessus causing respiratory tract infections in a Pediatric Intensive Care Unit (PICU) in Kuwait, its investigation and control measures.
  
  
  METHODS
  Respiratory secretions were obtained from ventilator-dependent patients showing signs of sepsis, including fever, malaise and weight loss. The specimens were cultured on appropriate routine media. After the results of the sample taken from the index case as acid-fast bacilli positive, all patients were screened for M. abscessus carriage. Isolates were identified by INNO-LiPA Mycobacteria v2 line probe assay and DNA sequencing. Molecular fingerprinting DiversiLab strain typing was performed on the isolates. Epidemiologic investigation was conducted during the outbreak.
  
  
  RESULTS
  the outbreak affected 5 patients, 4 of whom had severe infections including 1 patient with septicemia. Asymptomatic carriage of outbreak strain was found in 1 patient. All environmental samples were negative for M. abscessus but some were positive for M. gordonae and M. fortuitum. The source could not be identified. Stringent infection control measures were put in place, including reemphasizing hand hygiene and closure of the Pediatric Intensive Care Unit to new admissions. A year later, no further case has occurred after the last case.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of a hospital-acquired outbreak of respiratory tract infection caused by M. abscessus in a Pediatric Intensive Care Unit. In the absence of definite source identification, reinforcement of standard infection control guidelines was successful in containing the outbreak.
authors.affiliation: From the * Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait; † Microbiology Unit; ‡ Infection Control Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; § Microbiology and Immunology Department, Mansoura Faculty of Medicine, Mansoura, Egypt; ¶Pediatric Department, Mubarak Al Kabeer Hospital, Jabriya; and ‖National TB Reference Laboratory, Shuweikh, Kuwait.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Jamal
authors.forename: Mona F
authors.initials: MF
authors.lastname: Salama
authors.forename: G
authors.initials: G
authors.lastname: Al Hashem
authors.forename: M
authors.initials: M
authors.lastname: Rifaei
authors.forename: H
authors.initials: H
authors.lastname: Eldeen
authors.forename: Entesar H
authors.initials: EH
authors.lastname: Husain
authors.forename: S
authors.initials: S
authors.lastname: Ahmad
authors.forename: Vincent O
authors.initials: VO
authors.lastname: Rotimi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000235:genetics* / Q000302:isolation & purification*