Outbreak of Mycobacterium mucogenicum Bloodstream Infections among Patients with Sickle Cell Disease in an Outpatient Setting.

Ashraf MS, Swinker M, Augustino KL, Nobles D, Knupp C, Liles D, Christie J, Ramsey KM.

Source

Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina.

Abstract

Objective. To study an outbreak of Mycobacterium mucogenicum bloodstream infections in an outpatient setting. Design. Outbreak investigation and retrospective chart review. Setting. University outpatient clinic. Patients. Patients whose blood cultures tested positive for M. mucogenicum in May or June 2008. Methods. An outbreak investigation and a review of infection control practices were conducted. During the process, environmental culture samples were obtained. Isolates from patients and the environment were genotyped with the DiversiLab typing system to identify the source. Chart reviews were conducted to study the management and outcomes of the patients. Results. Four patients with sickle cell disease and implanted ports followed in the same hematology outpatient clinic developed blood cultures positive for M. mucogenicum. A nurse in the clinic had prepared intravenous port flushes on the sink counter, using a saline bag that was hanging over the sink throughout the shift. None of the environmental cultures grew M. mucogenicum except for the tap water from 2 rooms, 1 of which had a faucet aerator. The 4 patient isolates and the tap water isolate from the room with the aerator were found to have greater than 98.5% similarity. The subcutaneous ports were removed, and patients cleared their infections after a course of antibiotic therapy. Conclusion. The source of the M. mucogenicum bacteremia outbreak was identified by genotyping analysis as the clinic tap water supply. The preparation of intravenous medications near the sink was likely an important factor in transmission, along with the presence of a faucet aerator.