Mycobacterium chelonae Infection among Patients Receiving High-Flux Dialysis in a Hemodialysis Clinic in California

Abstract

Between July 1987 and January 1988, five patients dialyzed at a hemodialysis outpatient clinic developed systemic Mycobacterium chelonae abscessus (MCA) infections. Four of the five patients had arteriovenous graft infections, and two died during antimicrobial therapy. Case-patients were more likely than control-patients to have received high-flux dialysis during the 6 mo before their infection (100% vs. 30%, P = .009). MCA was cultured from the hose connected to a water spray device used for manual reprocessing of high-flux but not regular dialyzers. Renalin was the germicide used to manually disinfect dialyzers for reuse and was prepared at a concentration of 2.5%. Laboratory studies documented survival of MCA from two high-flux dialyzers that were reprocessed in a manner similar to that used in the clinic. Early diagnosis with complete rather than partial graft removal in combination with antimicrobial therapy is recommended for MCA graft infections. In addition, 2.5% Renalin did not appear to ensure complete killing of MCA in high-flux dialyzers that were manually reprocessed at this hemodialysis clinic.

Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

“…Infections caused by rapidly growing NTM have been reported following cardiac bypass surgery [19][20][21][22][23] , peritoneal dialysis 24 and middle ear cleaning 25 . Individuals tend to be predisposed to NTM infection e.g.…”

Iatrogenic outbreak of M. chelonae skin abscesses

“…(15), open heart and cardiac surgery [16,19,38], mammoplasty [17], dialysis [20][21][22] and in people who had undergone invasive procedures at a podiatry office [18]. In Colombia, since 1981, there have been reports of isolated cases with soft tissue lesions [14].…”

“…In most of the outbreaks caused by rapidly growing mycobacteria, the source and the nature of the responsible microorganism have not been established [1,15,20,21,24,25,41,42] but, in general, water, aqueous solutions and the environment have been suggested as the source of contamination. Wallace discusses the importance of geographic location, seasonal factors, adequacy of air filtration and the presence of nonsterile water in the operating room [38].…”

“…Only a few authors have shown results about risk factors [17,18,21,24,25], but none of them found personal characteristics including gender, age, route or number of injections associated with mycobacterial disease.…”

“…chelonae has been aetiologically implicated in several clinical syndromes which include not only organ-specific pathology but also disseminated disease [6]. Isolated cases are common [7][8][9][10][11][12][13][14] but outbreaks are not [15][16][17][18][19][20][21][22].…”