title: A cluster of central line-associated bloodstream infections due to rapidly growing nontuberculous mycobacteria in patients with hematologic disorders at a Japanese tertiary care center: an outbreak investigation and review of the literature.
abstract: BACKGROUND Rapidly growing nontuberculous mycobacteria (RGM) are considered rare pathogens, causing central line-associated bloodstream infection. We identified an outbreak of central line-associated bloodstream infection due to RGM at a hematology-oncology ward during a 5-month period. DESIGN Outbreak investigation and literature review. SETTING A Japanese tertiary care center. PATIENTS Adults who were hospitalized at the hematology-oncology ward from October 15, 2011, through February 17, 2012. RESULTS A total of 5 patients with a bloodstream infection due to RGM (4 cases of Mycobacterium mucogenicum and 1 case of Mycobacterium canariasense infection) were identified; of these, 3 patients had acute myeloid leukemia, 1 had acute lymphocytic leukemia, and 1 had aplastic anemia. Four of the 5 patients received cord blood transplantation prior to developing the bloodstream infection. All central venous catheters in patients with a bloodstream infection were removed. These patients promptly defervesced after catheter removal and their care was successfully managed without antimicrobial therapy. Surveillance cultures from the environment and water detected M. mucogenicum and M. canariasense in the water supply of the hematology-oncology ward. The isolates from the bloodstream infection and water sources were identical on the basis of 16S-rRNA gene sequencing. CONCLUSIONS The source of RGM in the outbreak of bloodstream infections likely was the ward tap water supply. Awareness of catheter-related bloodstream infections due to nontuberculous mycobacteria should be emphasized, especially where immunocompromised patients are at risk. Also, using antimicrobials after catheter removal to treat central line-associated bloodstream infection due to RGM may not be necessary. Infect Control Hosp Epidemiol 2015;36(1): 76-80.
authors: 1Division of Infectious Diseases,Department of Medicine,Tokyo Metropolitan Tama General Medical Center,Fuchu,Tokyo,Japan.
authors: Yasuaki
authors: Y
authors: Tagashira
authors: 2Department of Hematology,Tokyo Metropolitan Tama General Medical Center,Fuchu,Tokyo,Japan.
authors: Yasuji
authors: Y
authors: Kozai
authors: 3Department of Infection Prevention,Tokyo Metropolitan Tama General Medical Center,Fuchu,Tokyo,Japan.
authors: Hitomi
authors: H
authors: Yamasa
authors: 4Department of Microbiology,Department of Infection Prevention,Tokyo Metropolitan Tama General Medical Center,Fuchu,Tokyo,Japan.
authors: Masako
authors: M
authors: Sakurada
authors: 5Department of Internal Medicine,Tokyo Metropolitan Matsuzawa Hospital,Setagaya,Tokyo,Japan.
authors: Tetsuya
authors: T
authors: Kashiyama
authors: 1Division of Infectious Diseases,Department of Medicine,Tokyo Metropolitan Tama General Medical Center,Fuchu,Tokyo,Japan.
authors: Hitoshi
authors: H
authors: Honda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D060766:Drinking Water / Q000382:microbiology; D005260:Female; D006402:Hematologic Diseases / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000254:growth & development; D062606:Tertiary Care Centers; D014871:Water Microbiology
chemical_list: D060766:Drinking Water