Abscesses due to <i>Mycobacterium abscessus</i> Linked to Injection of Unapproved Alternative Medication

Galil, Karin; Miller, Lisa; Yakrus, Mitchell A.; Wallace, Richard J.; Mosley, David G.; England, Bob; Huitt, Gwen A.; McNeil, Michael M.; Perkins, Bradley A.

doi:10.3201/eid0505.990509

Cited by 90 publications

(75 citation statements)

References 25 publications

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“…As infecções associadas a ele incluem doença pulmonar, endocardite, otite média, mastoidite e ceratite. Outros tipos de infecções causadas por Mycobacterium (abcessus/ fortuitum/chelonae) foram identificados em procedimentos cirúrgicos estéticos como liposucção e lipoescultura, administração parenteral de vitaminas, extrato de córtex adrenal, lidocaína, silicone, tratamento de acupuntura, colocação de piercing mamilar e banhos em piscinas, uma vez que essa bactéria já foi encontrada em água tratada nas caixas d'água de hospitais (7)(8)(9)(10)(11)(12)(13)(14) . Sua presença nesses locais implica desdobramentos preocupantes, uma vez que foi fonte de problemas em vários setores de serviços de saúde, sendo associadas com fluidos de hemodiáli-se e soluções desinfetantes (6)(7)13) .…”

Section: Discussionunclassified

Infecção por micobactéria após videoartroscopia: o glutaraldeído pode ser o culpado? Estudo experimental in vitro

et al. 2008

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Section: Discussionunclassified

Infecção por micobactéria após videoartroscopia: o glutaraldeído pode ser o culpado? Estudo experimental in vitro

et al. 2008

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“…This analysis identified BMI, vial age at injection, and an 11 day injection period as risk factors for the development of adverse events following injection with pf-MPA from MSFP. Given the potential health risks associated with the injection of preservative-free compounded pharmaceutical products, it is imperative to identify risk factors associated with adverse events in order to implement effective preventative measures [2,5,9,10]. Remote electronic access to the complete medical records for the 143 patients with identified exposure to pf-MPA from MSFP lots numbered 011413dan or 1201612dan greatly assisted in this investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Identified sources include intrinsically contaminated product or a breakdown in infection control practices leading to extrinsic contamination of the product [1][2][3][4][5] In September 2012, a national outbreak investigation involving the New England Compounding Center (NECC), identified at least 61 deaths and 749 adverse events from intrinsically contaminated preservative-free Methylprednisolone acetate (pf-MPA) primarily injected through epidural or intraspinal sites [6][7][8][9]. In addition to the NECC outbreak as of 2012, 11 outbreaks are known to have occurred since January 2000 in which compounded products have resulted in an additional 207 infections and 17 deaths [10].…”

Section: Introductionmentioning

confidence: 99%

Polymicrobial Injection-Site Abscesses Associated with Contaminated Methylprednisolone Injections in Florida

Matthias¹

2017

RMES

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Objective: Identify injection-site abscesses and quantify risk factors from injections with subsequently recalled preservative-free Methylprednisolone acetate (pf-MPA) from Main Street Family Pharmacy (MSFP). Design:Outbreak investigation and retrospective cohort study. Setting:Private primary healthcare facility.Patients: Three hundred and seven patients that received pf-MPA injections manufactured by MSFP from December 1, 2012 through February 28, 2013.Methods: Medical records were abstracted for individuals with an adverse event and individuals with known exposure to pf-MPA lots 011413dan and 120612dan. Records were analyzed for factors related to injection-site adverse events using logistic regression. Facility records from 2006 through 2013 were queried for International Classification of Diseases, 9 th edition, Clinical Modification (ICD-9-CM) diagnosis codes 682.5 and 680.5 to identify additional adverse events. Results:Sixteen of 307 injected individuals (attack rate = 5.2%) were identified with adverse events consisting of soft tissue infections at the injection site. Increasing body mass index (BMI) (odds ratio [OR] =1.17; 95% CI=1.04-1.33), age of vial at injection (OR=1.13; 95% CI=1.00-1.27), and date of injection (OR=10.01; 95% CI=1.49-67.11) were associated with adverse events. Conclusion:Risk of soft tissue infections following injection of recalled MSFP pf-MPA was greater among persons with higher BMI, receiving older product, and receiving injections from February 5 through February 15, 2013. Appropriate needle length was not used for patients with a greater BMI. A written protocol for pf-MPA injections including needle length and gauge should be created and trainings on this protocol provided to staff administering injections. Compounded pharmaceuticals, especially preservative-free formulations, should not be utilized for multiple injections.

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Section: Introductionmentioning

confidence: 99%

“…RGM-associated disease tends to be sporadic and usually associated with injury or surgical procedures (Wright & Wallace, 1995). However, large outbreaks of post-operative wound infections (Chadha et al, 1998) and post-injection abscesses (Galil et al, 1999 ;Villaneuva et al, 1997) have been attributed to contami-M. abscessus was originally classified as a subspecies of M. chelonae but has been reclassified as a distinct species on the basis of DNA-DNA hybridization and sequence analysis of the 16S rRNA gene (Kusunoki & Ezaki, 1992 ;Pitulle et al, 1992). Some phylogenetic analyses place M. abscessus close to M. chelonae (Brown et al, 1999 ;Domenech et al, 1997), whereas others place it on an older branch of the phylogenetic tree (Pitulle et al, 1992 ;Shojaei et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

A polymorphic region in Mycobacterium abscessus contains a novel insertion sequence element b bThe GenBank accession number for the sequence reported in this paper is AF513500.

2002

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A polymorphic region was discovered in the genetically uncharacterized opportunistic pathogen Mycobacterium abscessus. The region contains a novel 17 kb insertion sequence (IS) named ISMab1. ISMab1 contains two complete ORFs and one partial ORF located in segments with over 80 % nucleotide identity to Mycobacterium avium IS1601 and IS999 and to previously unreported IS-like elements from Mycobacterium smegmatis. The marked similarity within this family of elements is supportive of horizontal transfer between environmental mycobacterial species. In clinical isolates, ISMab1 was either present as a single copy or absent. The polymorphic region containing ISMab1 was identified by genomic subtraction between a parental strain and phenotypic variant. The variant has a 142 kb genomic deletion and this is flanked in the parental strain by complex arrays of inverted and direct repeats. Clinical isolates of M. abscessus were probed for the deletion and flanking sequences and two were found to be missing more than 20 kb. No regional deletions were found in the type strain, ATCC 19977. Although M. abscessus is a rapidly growing species, comparative sequence analysis of 23 kb from the polymorphic region showed that most local ORFs have greater amino acid identity to proteins encoded by genes from the slowly growing mycobacteria, M. avium and Mycobacterium tuberculosis, than to the rapid-grower M. smegmatis. Several ORFs also have strong similarity to Pseudomonas aeruginosa genes with a potential role in β-oxidation.Keywords : rapidly growing mycobacteria, insertion element, horizontal transfer, genetic variation INTRODUCTIONThe genus Mycobacterium has been divided into two groups on the basis of growth rate and, in general, this division is supported by phylogenetic analyses of the 16S rRNA gene (Pitulle et al., 1992). The major pathogens Mycobacterium leprae, the Mycobacterium tuberculosis complex and Mycobacterium avium complex, are members of the slowly growing mycobacteria. The second group, the rapidly growing mycobacteria (RGM), in- Abbreviations : DR, direct repeat ; IR, inverted repeat ; IS, insertion sequence ; RGM, rapidly growing mycobacteria.The GenBank accession number for the sequence reported in this paper is AF513500.cludes saprophytic species found in soil and water systems (Falkinham, 1996 ;Howard & Byrd, 2000). Comparative analysis of 16S rRNA gene sequences indicates that the RGM may be the phylogenetically older group (Pitulle et al., 1992).Several species of RGM, particularly Mycobacterium abscessus, Mycobacterium chelonae and Mycobacterium fortuitum, are opportunistic pathogens and can cause infections ranging from localized abscesses to pulmonary and disseminated disease (Griffith et al., 1993 ;Howard & Byrd, 2000 ;Wright & Wallace, 1995). RGM-associated disease tends to be sporadic and usually associated with injury or surgical procedures (Wright & Wallace, 1995). However, large outbreaks of post-operative wound infections (Chadha et al., 1998) and post-injection abscesses (Galil et al., 1999 ; Vill...

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Abscesses due to Mycobacterium abscessus Linked to Injection of Unapproved Alternative Medication

Cited by 90 publications

References 25 publications

Infecção por micobactéria após videoartroscopia: o glutaraldeído pode ser o culpado? Estudo experimental in vitro

Infecção por micobactéria após videoartroscopia: o glutaraldeído pode ser o culpado? Estudo experimental in vitro

Polymicrobial Injection-Site Abscesses Associated with Contaminated Methylprednisolone Injections in Florida

A polymorphic region in Mycobacterium abscessus contains a novel insertion sequence element b bThe GenBank accession number for the sequence reported in this paper is AF513500.

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