Pediatric Dental Clinic–Associated Outbreak of Mycobacterium abscessus Infection

Hatzenbuehler, Lindsay A.; Tobin-D’Angelo, Melissa; Drenzek, Cherie; Peralta, Gianna; Cranmer, Lisa C; Anderson, Evan J.; Milla, Sarah Sarvis; Abramowicz, Shelly; Yi, Jumi; Hilinski, Joseph A.; Rajan, Roy; Whitley, Matthew K; Gower, Verlia; Berkowitz, Frank E.; Shapiro, Craig A.; Williams, Joseph K.; Harmon, Paula; Shane, Andi L.

doi:10.1093/jpids/pix065

Cited by 42 publications

(31 citation statements)

References 25 publications

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“…Two immunocompromised patients have presented a dental abscess associated with Pseudomonas aeruginosa after exposure to DUWL water contaminated by this microorganism [6]. Groups of children developed infections with Mycobacterium abscessus after having pulpotomy in a hospital in which DUWL were contaminated by this nontuberculous mycobacterium [7,8]. Infectious risk can also affect the healthcare workers [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of BRS® and Alpron®/Bilpron® Disinfectants for Dental Unit Waterlines: A Six-Year Study

Baudet

Lizon²,

Martrette

et al. 2020

IJERPH

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Biofilms in dental unit waterlines (DUWL) are a potentially significant source of contamination posing a significant health risk as these may come into contact with patients and dental staff during treatment. The aim of this study was to evaluate the microbiological quality of DUWL water treated by Biofilm-Removing-System® (BRS®) and Alpron®/Bilpron® disinfectant solutions for six years in a French university hospital. The microbiological quality of water supplied by 68 dental units—initially shock treated with BRS®, then continuously treated by Alpron® with sterile water during working days and Bilpron® during inactivity period, and combined with purging every morning and after each patient—was assessed biannually during six years for total culturable aerobic bacteria at 22 °C and 36 °C, Legionella sp., Pseudomonas aeruginosa, and total coliforms. A total of 628 samples were analyzed, 99.8% were compliant with extended microbiological levels, and we never detected pathogen bacteria like Legionella sp. and P. aeruginosa. Only one sample (0.2%) was noncompliant with the level of total culturable aerobic bacteria at 36 °C, which exceeded 140 colony forming units per mL. The protocol implemented in our university hospital gives excellent results and enables control of the microbiological quality of DUWL water in the long term.

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Section: Introductionmentioning

confidence: 99%

Efficacy of BRS® and Alpron®/Bilpron® Disinfectants for Dental Unit Waterlines: A Six-Year Study

Baudet

Lizon²,

Martrette

et al. 2020

IJERPH

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“…The presence of NTM in the water should also be monitored after disinfection of the waterlines as the use of a low-level disinfectant will remove most bacteria but can lead to an accumulation of NTM. In Caracas, Venezuela, and also in the USA, outbreaks of NTM infections have been registered as being associated with NTM-contaminated water in DUWLs [14][15][16]. In order to keep patients safe, one must use water of an appropriate microbiological quality or sterile water, especially when surgical procedures are performed and/or when treating certain groups of people, e.g., immunocompromised and older patients.…”

Section: Discussionmentioning

confidence: 99%

“…Our research shows that they can be isolated and identified from water in DUWLs. Moreover, outbreaks due to these bacteria after odontological care have recently been reported I the USA and in Venezuela [14][15][16].…”

Section: Nontuberculous Mycobacteria In Duwlsmentioning

confidence: 99%

“…In Georgia, in 2015, 24 children were diagnosed with a severe infection due to Mycobacterium abscessus after a pulpotomy procedure carried out in a pediatric dentistry clinic, and 17 children required antibiotic treatment and the surgical excision of infected tissue. Examination of the water used during the procedure showed bacterial contamination far in excess of allowable concentrations, and M. abscessus was isolated from all water samples of the main supplies and DUWLs [14]. In 2016, the largest outbreak of odontogenic mycobacterial infections described to date was registered in California due to a pediatric dental clinic's contaminated water system.…”

Section: Introductionmentioning

confidence: 99%

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Dental Unit Waterlines in Quito and Caracas Contaminated with Nontuberculous Mycobacteria: A Potential Health Risk in Dental Practice

Realpe

Gutiérrez

Sierra

et al. 2020

IJERPH

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Three cases of severe odontogenic infections due to nontuberculous mycobacteria (NTM) in Venezuela that were directly associated with dental procedures and the finding of dental unit waterlines (DUWLs) in dental offices that were colonized with mycobacteria species was the reason for assessing the water quality of DUWLs in dental offices in two capital cities in South America, namely, Quito and Caracas. The main water supplies and the water from 143 DUWLs in both cities were sampled and especially checked for contamination with NTM. To measure the overall bacteriological quality of the water also the presence of heterotrophic bacteria, coliform bacteria, and Pseudomonas was determined. Results showed that respectively 3% and 56% of the DUWLs in Quito and Caracas yielded NTM species (up to 1000 colony-forming units (CFU)/mL). Furthermore, high and unacceptable total viable counts of heterotrophic bacteria and/or coliform bacteria and Pseudomonas were detected in 73% of the samples. We conclude that, in both cities, the water in the majority of DUWLs was contaminated with NTM and other potential pathogens, presenting a risk to human health. The detection of NTM in DUWL water with acceptable heterotrophic bacteria counts shows the need to include NTM in water quality testing. Mycobacteria are more resistant to disinfection procedures than other types of vegetative bacteria, and most testing protocols for DUWLs do not assess mycobacteria and thus do not guarantee risk-free water.

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“…Adenitis was the principal clinical feature of an outbreak of odontogenic M. abscessus infections involving 24 children, who underwent pulpotomy at a single dental practice in Georgia between October 2013 and September 2015. 120 Pulpotomy is not considered to be a surgical procedure and consequently, municipal water is often used during drilling and irrigation. Water samples from the dental chairs were contaminated with M. abscessus in quantities that exceeded the Environmental Protection Agency's microbiologic cutoff safety standard for drinking water by 180-fold.…”

Section: Cervicofacial Adenitismentioning

confidence: 99%

Management of Extrapulmonary Nontuberculous Mycobacterial Infections

Holt

Kasperbauer

2018

Semin Respir Crit Care Med

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Extrapulmonary disease occurs in a minority of nontuberculous mycobacterial (NTM) infections. The pattern of disease tends to be multifocal in immunocompromised individuals and localized in the immunocompetent. There is increasing recognition of disseminated infection, as a complication of cardiac surgery, and focal infections due to rapidly growing mycobacteria. Microbiologic diagnosis requires detection of NTM in blood or tissue samples by microscopy, culture, or molecular methods. Management of extrapulmonary NTM infection requires prolonged, targeted multiple-drug therapy and, in some cases, aggressive surgical intervention. The optimal treatment approach is often unknown. Despite combined medical and surgical therapy, outcomes may be poor. A high degree of clinical suspicion and early diagnosis are required to maximize chances of a positive outcome.

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Pediatric Dental Clinic–Associated Outbreak of Mycobacterium abscessus Infection

Cited by 42 publications

References 25 publications

Efficacy of BRS® and Alpron®/Bilpron® Disinfectants for Dental Unit Waterlines: A Six-Year Study

Efficacy of BRS® and Alpron®/Bilpron® Disinfectants for Dental Unit Waterlines: A Six-Year Study

Dental Unit Waterlines in Quito and Caracas Contaminated with Nontuberculous Mycobacteria: A Potential Health Risk in Dental Practice

Management of Extrapulmonary Nontuberculous Mycobacterial Infections

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