Mycobacterium xenopi spinal infections after discovertebral surgery: investigation and screening of a large outbreak

Astagneau, Pascal; Desplaces, Nicole; Vincent, Véronique; Chicheportiche, Valérie; Botherel, A.H; Maugat, S.; Lebascle, Karine; Léonard, Philippe; Desenclos, J C; Grosset, J; Ziza, Jean Marc; Brücker, Gilles

doi:10.1016/s0140-6736(01)05843-3

Cited by 95 publications

(44 citation statements)

References 25 publications

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“…As the device was insufficiently dried before reuse, residual water on the surface could suffuse along the needle and then contaminate further injections. This hypothesis is supported by the findings in other studies describing a similar mechanism of NTM transmission related to the use of nonsterile water to disinfect devices used for discovertebral or plastic surgery (1,3).…”

Section: Case Reportsupporting

confidence: 80%

Outbreak of Nontuberculous Mycobacterial Subcutaneous Infections Related to Multiple Mesotherapy Injections

et al. 2009

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We describe an outbreak of severe subcutaneous infections due to nontuberculous mycobacteria following mesotherapy. Epidemiological studies and molecular comparisons of Mycobacterium chelonae strains from different patients and the environment suggested that contamination may be associated with inappropriate cleaning of the multiple-injection device with tap water. CASE REPORTIn January 2007, a general practitioner notified the health authorities and the regional center for nosocomial infection control of a cluster of subcutaneous infections due to nontuberculosis mycobacteria (NTM) following mesotherapy.A complete screening for all potentially exposed patients who underwent mesotherapy with the practitioner from 1 October 2006 (the date of the first mesotherapy in the medical room suspected of contamination) to 15 January 2007 (the date of disruption of the mesotherapy practice) was designed. Each patient was contacted both by phone and by mail and urged to be examined by a specialist in the department of infectious diseases at a tertiary-care reference hospital in Paris. A retrospective cohort study of all exposed patients was performed to describe the temporal and spatial distribution of cases and identify risk factors. A case was defined as certain if the exposed patient had clinical subcutaneous lesions at the site of mesotherapy injections in association with cultures positive for NTM. A case was defined as probable if the exposed patient had clinical subcutaneous lesions but smear and culture results negative for NTM. An assessment study of hygiene practices was performed by an infection control practitioner at the outpatient clinic to determine potential risk factors to be tested in a comparative epidemiological study. Risk factors included the day of an outpatient visit, a patient's place in a series of patients receiving therapy on the same day, and the site of and reason for injections. For each case, the incubation period was estimated as the time between the last mesotherapy session before the onset of symptoms and the date of the first symptoms of NTM infection. Comparisons of means and proportions were calculated with standard statistics. As the clinic was closed on Wednesdays, Saturdays, and Sundays, visits on the days after closure, i.e., Mondays and Thursdays, were considered as a potential risk factor, expressed as the number of such visits per 100 patient visits. Multivariate analysis was performed using stepwise logistic regression with P-to-enter and P-to-remove values at 0.20. The Hosmer-Lemeshow statistic was used to test the goodness of fit of the model. All calculations were performed using SAS software release 8.02 (SAS Institute, Cary, NC) and considered significant at P of Ͻ0.05.Samples from tap water in the medical examination room, as well as from the injection device and topical creams, were examined to search for mycobacteria. Products used for mesotherapy injections were recovered from the office and analyzed by the laboratory of the French Agency for Sanitary Safety in Health P...

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Section: Case Reportsupporting

confidence: 80%

Outbreak of Nontuberculous Mycobacterial Subcutaneous Infections Related to Multiple Mesotherapy Injections

et al. 2009

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“…Also, because most HIV-infected patients receive highly active antiretroviral therapy, fewer cases of severe HIV immunosuppression and its co-infections are seen. HIV infection predisposes patients to extrapulmonary M. xenopi infection, especially spinal infection (6,19). Those with HIV-associated spinal M. xenopi infection had rising CD4 counts after starting or changing highly active antiretroviral therapy regimens (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary M. xenopi infections are most common, but extrapulmonary and disseminated infections have also been recorded (5,6). A predisposing factor is impaired immunity, either local (e.g., pre-existing pulmonary disease) or systemic (e.g., hematologic malignancy, immunosuppressive medication, or HIV/AIDS) (5,7).…”

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confidence: 99%

“…Its survival in fl owing water systems and resistance to common disinfectants enables M. xenopi to contaminate laboratory samples and medical devices such as bronchoscopes, thus causing healthcare-acquired (pseudo) infections and laboratory cross-contaminations (3,6,8,9). Differentiating true infection from pseudoinfection is of paramount importance because treatment of M. xenopi infections is time-consuming and often complicated.…”

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confidence: 99%

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Mycobacterium xenopiClinical Relevance and Determinants, the Netherlands

Ingen

Boeree

Lange

et al. 2008

Emerg. Infect. Dis.

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In the Netherlands, isolation of Mycobacterium xenopi is infrequent, and its clinical relevance is often uncertain. To determine clinical relevance and determinants, we retrospectively reviewed medical fi les of all patients in the Netherlands in whom M. xenopi was isolated from January 1999 through March 2005 by using diagnostic criteria for nontuberculous mycobacterial infection published by the American Thoracic Society. We found 49 patients, mostly white men, with an average age of 60 years and pre-existing pulmonary disease; of these patients, 25 (51%) met the diagnostic criteria. Mycobacterial genotype, based on 16S rRNA gene sequencing, was associated with true infection. Most infections were pulmonary, but pleural and spinal infections (spinal in HIV-infected patients) were also noted. Treatment regimens varied in content and duration; some patients were overtreated and some were undertreated. M ycobacterium xenopi was fi rst described by Schwabacher in 1959; it was isolated from skin lesions in a clawed frog and named after the offi cial species designation of the frog, Xenopus laevis (1). Thereafter, these slowgrowing mycobacteria have been recovered from heated water systems in many countries and more recently from natural waters in Finland (2). Transmission to humans is believed to originate from the environment, through aerosol inhalation or ingestion. Human-to-human transmission and transmission from animal reservoirs remain controversial because these routes have not been proven by molecular typing (3,4).Pulmonary M. xenopi infections are most common, but extrapulmonary and disseminated infections have also been recorded (5,6). A predisposing factor is impaired immunity, either local (e.g., pre-existing pulmonary disease) or systemic (e.g., hematologic malignancy, immunosuppressive medication, or HIV/AIDS) (5,7).Its survival in fl owing water systems and resistance to common disinfectants enables M. xenopi to contaminate laboratory samples and medical devices such as bronchoscopes, thus causing healthcare-acquired (pseudo) infections and laboratory cross-contaminations (3,6,8,9). Differentiating true infection from pseudoinfection is of paramount importance because treatment of M. xenopi infections is time-consuming and often complicated. The British Thoracic Society (BTS) trial in 2001 established that treatment for pulmonary infections should consist of a 2-year course of rifampin and ethambutol; regimens including macrolides or fl uoroquinolones are still being investigated (10). The American Thoracic Society (ATS) established general criteria for the diagnosis and treatment of nontuberculous mycobacterial, not specifi cally M. xenopi, infections. The treatment guidelines are similar to those by the BTS, although the ATS guidelines advocate macrolidecontaining regimens (5).To assess frequency and clinical relevance of M. xenopi isolation and its determinants in the Netherlands, we performed a retrospective case study. We used the ATS diagnostic criteria available during the study period to diff...

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“…Exposure to water droplets aerosolised from contaminated hospital water systems has been linked to pulmonary MAC infection 10,[32][33][34] but other routes of infection are possible. In 1976, NTM infections following cardiac surgery were attributed to porcine heart valves contaminated with M. fortuitum and M. chelonae [35][36][37] .…”

Section: Ntm and Cardiac Surgerymentioning

confidence: 99%

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

Walker

Moore

Collins

et al. 2017

Journal of Hospital Infection

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Summary:The role of heater cooler units (HCUs) in the transmission of Mycobacterium chimaera during open heart surgery has been recognised since 2013. Subsequent investigations uncovered a remarkable global outbreak reflecting the wide distribution of implicated devices. HCUs are an essential component of cardiopulmonary bypass operations and their withdrawal would severely affect capacity for life-saving cardiac surgery. However, studies have demonstrated that many HCUs are contaminated with a wide range of microorganisms, including M. chimaera and complex biofilms. Whole genome sequencing of M. chimaera isolates recovered from one manufacturer's HCUs, worldwide, has demonstrated a high level of genetic similarity, for which the most plausible hypothesis is a point source contamination of the devices. Dissemination of bioaerosols through breaches in the HCU water tanks is the most likely route of transmission and airborne bacteria have been shown to have reached the surgical field even with the use of ultraclean theatre ventilation. Controlling the microbiological quality of the water circulating in HCUs and reducing biofilm formation has been a major challenge for many hospitals. However, enhanced decontamination strategies have been recommended by manufacturers and while not always effective in eradicating M. chimaera from HCUs, UK hospitals have not reported any new cases of M. chimaera infection, since implementing these mitigation strategies. Water safety groups in hospitals should be aware that water in medical devices such as HCUs can act as a vector in the transmission of potentially fatal water-borne infections.

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Mycobacterium xenopi spinal infections after discovertebral surgery: investigation and screening of a large outbreak

Cited by 95 publications

References 25 publications

Outbreak of Nontuberculous Mycobacterial Subcutaneous Infections Related to Multiple Mesotherapy Injections

Outbreak of Nontuberculous Mycobacterial Subcutaneous Infections Related to Multiple Mesotherapy Injections

Mycobacterium xenopiClinical Relevance and Determinants, the Netherlands

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

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