Naslov
Nosocomial Mycobacterium gordonae pseudo-outbreak associated with hospital’s water supplies contamination and impact on patients treatment

Autori
Žmak, Ljiljana ; Zlojtro, Marija ; Janković, Mateja ; Samaržija, Miroslav ; Katalinić-Janković, Vera ; Obrovac, Mihaela ; Jakopović, Marko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Scientific Program including Abstracts / Niemann, Stefan - Werne : Agency KONSENSUS Ltd, 2014, 84-85

ISBN
978-3-00-046188-0

Skup
35th Annual Congress of the European Society of Mycobacteriology

Mjesto i datum
Beč, Austrija, 29.06.2014. - 02.07.2014

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Mycobacterium gordonae; nontuberculous mycobacteria; pseudo-outbreak; water contamination

Sažetak
Nontuberculous mycobacteria (NTM) encompass all Mycobacterium species other than M.tuberculosis complex and M.leprae. Currently, there have been over 150 species of Mycobacterium identified. Due to their ubiquitous presence in municipal water supplies, exposure to NTM is likely common, however these opportunistic pathogens can colonize respiratory tract without causing true disease. Currently in Croatia, rapid tests for identifying M.tuberculosis are not routinely available and the identification of clinical isolates of mycobacteria at the species level is primarily based on the characteristics of the cultured bacteria, biochemical test results and for some species identification by molecular methods. Because definitive identification of mycobacterial species can take several weeks, patients who have respiratory specimens positive for AFB present a public health dilemma. In 2009 a relative increase in the isolation of NTM from pulmonary samples originated from General Hospital Zabok was noted by the National Mycobacterial Reference Laboratory, Zagreb. Since more than 95% of all isolates were later identified as M. gordonae, pseudo-outbreak caused by this pathogen in a newly constructed hospital building was suspected. Namely, the building containing Department for respiratory diseases was opened for business in 2008. Retrospective epidemiological survey was conducted to asses possible contamination of patient samples with NTM. Total of 150 individual cases with pulmonary NTM isolates were identified in the period 2007-2012, with M. gordonae being the most frequently isolated species (n=135 ; 90%). Epidemiological service performed inspection and confirmed a contamination of tap water with M. gordonae in multiple sites throughout the plumbing system of the new building. Since the tap water is potable in Croatia, it was presumed that drinking and/or gargling was the reason of the rise and pseudo-outbreak of M. gordonae infections in our patients. Accordingly, guidelines for physicians, nurses and patients were issued, advising avoidance of drinking tap water or even rinsing the mouth prior to giving the sputum sample. None of the 150 cases met the ATS/IDSA criteria for pulmonary NTM disease, and concomitant M. tuberculosis infection was confirmed in only 6 (4%) patients. Still, because of low awareness about NTM infections, in a significant proportion of patients (n=64 ; 42.6%), tuberculosis was diagnosed and anti-tuberculosis treatment was initiated. In addition to increased risk of drug-related adverse events and unnecessary expense for the patient and the hospital, patient’s contacts were involved in unnecessary physical exams, together with radiological and laboratory testing. Our work point out the importance of faster NTM identification in patient samples as well as the continuing education about NTM among hospital personnel.

Izvorni jezik
Engleski

Znanstvena područja
Javno zdravstvo i zdravstvena zaštita

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