title: Nosocomial pseudo-outbreak of Mycobacterium gordonae associated with a hospital's water supply contamination: a case series of 135 patients.
abstract: Nontuberculous mycobacteria (NTM) are opportunistic pathogens found in natural and human-engineered waters. In 2009, a relative increase in the isolation of Mycobacterium gordonae from pulmonary samples originating from General Hospital Zabok was noted by the National Mycobacteria Reference Laboratory. An epidemiological survey revealed a contamination of the cold tap water with M. gordonae and guidelines regarding sputum sample taking were issued. In addition, all incident cases of respiratory infection due to NTM reported from 2007 to 2012 at General Hospital Zabok were included in a retrospective review. Out of 150 individual NTM isolates, M. gordonae was the most frequently isolated species (n = 135; 90%) and none of the cases met the criteria of the American Thoracic Society for pulmonary NTM disease. While concomitant Mycobacterium tuberculosis infection was confirmed in only 6 (4%) patients, anti-tuberculosis treatment was initiated for a significant portion of patients (n = 64; 42.6%) and unnecessary contact tracing was performed. This study points out the need to enhance the knowledge about NTM in our country and indicates the importance of faster NTM identification, as well as the importance of good communication between laboratory personnel and physicians when evaluating the significance of the isolated NTM.
authors.affiliation: Department for Respiratory Diseases, General Hospital Zabok, Bracak 8, 49210 Zabok, Croatia.
authors.forename: Marija
authors.initials: M
authors.lastname: Zlojtro
authors.affiliation: Department for Respiratory Diseases, University Hospital Centre Zagreb, Jordanovac 104, 10000 Zagreb, Croatia E-mail: mateja.jankovic@gmail.com.
authors.forename: Mateja
authors.initials: M
authors.lastname: Jankovic
authors.affiliation: Department for Respiratory Diseases, University of Zagreb Medical School, University Hospital Centre, Salata 3 10000 Zagreb, Croatia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Samarzija
authors.affiliation: National Mycobacterial Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Rockefellerova ulica 7, 10000 Zagreb, Croatia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Zmak
authors.affiliation: National Mycobacterial Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Rockefellerova ulica 7, 10000 Zagreb, Croatia.
authors.forename: Vera Katalinic
authors.initials: VK
authors.lastname: Jankovic
authors.affiliation: National Mycobacterial Reference Laboratory, Croatian National Institute of Public Health, Zagreb, Rockefellerova ulica 7, 10000 Zagreb, Croatia.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Obrovac
authors.affiliation: University of Zagreb Medical School, Salata 3, 10000 Zagreb, Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Zlojtro
authors.affiliation: Department for Respiratory Diseases, University of Zagreb Medical School, University Hospital Centre, Salata 3 10000 Zagreb, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Jakopovic
mesh_terms: D000368:Aged; D017523:Croatia / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008168:Lung / Q000382:microbiology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D014871:Water Microbiology; D014881:Water Supply / Q000032:analysis*