title: Infection control strategies that successfully controlled an outbreak of Mycobacterium abscessus at a cystic fibrosis center.
abstract: BACKGROUND
  Mycobacterium abscessus infection in patients with cystic fibrosis (CF) can result in accelerated clinical decline and the potential for direct or indirect transmission between patients has been recently demonstrated. Data on the outcomes of M abscessus outbreaks and the efficacy of specific infection control procedures in patients with CF remain limited. This study provides follow-up from an outbreak of pulmonary M abscessus in our center, highlighting outcomes and strategies that appear to have prevented further spread of the organism.
  
  
  METHODS
  Data from our adult CF center (1989-2015) were analyzed, including chart reviews of all patients with positive mycobacterial sputum cultures, cultures from environment surfaces, and epidemiologic evaluation of infected patients. Following an M abscessus outbreak in 2009, infection control policies were intensified based on CF guidelines and surveillance data were collected and reviewed.
  
  
  RESULTS
  Five cases of M abscessus were involved in the outbreak; 3 patients died during follow-up. An environment search failed to reveal an intermediary source of transmission between patients. After implementation of infection control measures composed of staff/patient education, environment sterilization, and patient isolation, no new cases were detected.
  
  
  CONCLUSIONS
  Direct or indirect patient-to-patient transmission of M abscessus is a threat in the CF population. A multifaceted infection control strategy based on CF guidelines was effective in halting transmission in our center.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA. Electronic address: skap@uw.edu.
authors.forename: Siddhartha G
authors.initials: SG
authors.lastname: Kapnadak
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Hisert
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington Medical Center, Seattle, WA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Pottinger
authors.affiliation: Division of Allergy and Infectious Disease, University of Washington Medical Center, Seattle, WA.
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA.
authors.forename: Moira L
authors.initials: ML
authors.lastname: Aitken
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D003550:Cystic Fibrosis / Q000150:complications*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D013183:Sputum / Q000382:microbiology; D055815:Young Adult
keywords: Cystic fibrosis; Infection control; Infection outbreak; Infection transmission; Mycobacterium abscessus; Nontuberculous mycobacteria