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Outbreak of Mycobacterium chelonae infection associated with use of jet injectors
J D Wenger1, J S Spika, R W Smithwick
1Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333.
Abstract:
Between January 1 and May 15, 1988, foot infections due to Mycobacterium chelonae subspecies abscessus were diagnosed in eight persons who had undergone invasive procedures at a podiatry office. A cohort study was performed to evaluate risk factors for disease. Persons who underwent procedures before 10:30 AM were more likely to have developed infection than those with procedures after that time (relative risk, 5.6). In addition, procedures involving any of the second through fourth toes were more likely to have resulted in infection than procedures involving only the first and/or fifth toes (relative risk, 4.4). Persons with 0, 1, or 2 risk factors had attack rates of 5%, 14%, and 60%, respectively. Mycobacterium chelonae subspecies abscessus organisms of the same antimicrobial resistance pattern as the patients' strains were cultured from distilled water in a reusable, nonsterilized container. A jet injector used to administer lidocaine was held between procedures in a mixture of the distilled water and a disinfectant as recommended by the manufacturer. Inoculation of patients with mycobacteria by the jet injector may have only occurred early in the day due to slow killing of the bacteria by the disinfectant. The outbreak emphasizes the pathogenicity of this water-associated organism and the need for high-level disinfection of jet injectors.
Insights
Foot infections caused by Mycobacterium chelonae subspecies abscessus were linked to early morning podiatry procedures and specific toe involvement. Contaminated water in a reusable jet injector was identified as the likely source of these infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Podiatric Medicine
Background:
- An outbreak of foot infections occurred between January and May 1988.
- Eight individuals were diagnosed with infections caused by Mycobacterium chelonae subspecies abscessus following podiatry procedures.
Purpose of the Study:
- To identify risk factors associated with Mycobacterium chelonae subspecies abscessus infections in patients undergoing podiatry procedures.
- To determine the source and transmission route of the identified infections.
Main Methods:
- A cohort study was conducted to evaluate risk factors.
- Environmental samples, including distilled water from a reusable container, were cultured.
- Mycobacterium chelonae subspecies abscessus strains from patients and environmental sources were analyzed for antimicrobial resistance patterns.
Main Results:
- Procedures performed before 10:30 AM were associated with a higher risk of infection (relative risk, 5.6).
- Procedures involving the second through fourth toes had a higher infection risk (relative risk, 4.4).
- Mycobacterium chelonae subspecies abscessus was isolated from distilled water used in a reusable, nonsterilized container for a jet injector.
Conclusions:
- The outbreak was likely caused by patient inoculation with mycobacteria via a contaminated jet injector.
- Early morning procedures may have increased risk due to insufficient disinfection time.
- High-level disinfection of medical devices like jet injectors is crucial to prevent infections from water-associated organisms.