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Published on: February 9, 2011
An outbreak of Mycobacterium abscessus infection in a Pediatric Intensive Care Unit in Kuwait
Wafaa Jamal1, Mona F Salama, G Al Hashem
1From the * Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait; † Microbiology Unit; ‡ Infection Control Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; § Microbiology and Immunology Department, Mansoura Faculty of Medicine, Mansoura, Egypt; ¶Pediatric Department, Mubarak Al Kabeer Hospital, Jabriya; and ‖National TB Reference Laboratory, Shuweikh, Kuwait.
Background:
Mycobacterium abscessus has been associated with respiratory tract infections, localized skin and soft tissue infections and sepsis. However, outbreaks of M. abscessus are rare.
Aim:
to report an outbreak of M. abscessus causing respiratory tract infections in a Pediatric Intensive Care Unit (PICU) in Kuwait, its investigation and control measures.
Methods:
Respiratory secretions were obtained from ventilator-dependent patients showing signs of sepsis, including fever, malaise and weight loss. The specimens were cultured on appropriate routine media. After the results of the sample taken from the index case as acid-fast bacilli positive, all patients were screened for M. abscessus carriage. Isolates were identified by INNO-LiPA Mycobacteria v2 line probe assay and DNA sequencing. Molecular fingerprinting DiversiLab strain typing was performed on the isolates. Epidemiologic investigation was conducted during the outbreak.
Findings:
the outbreak affected 5 patients, 4 of whom had severe infections including 1 patient with septicemia. Asymptomatic carriage of outbreak strain was found in 1 patient. All environmental samples were negative for M. abscessus but some were positive for M. gordonae and M. fortuitum. The source could not be identified. Stringent infection control measures were put in place, including reemphasizing hand hygiene and closure of the Pediatric Intensive Care Unit to new admissions. A year later, no further case has occurred after the last case.
Conclusion:
To our knowledge, this is the first report of a hospital-acquired outbreak of respiratory tract infection caused by M. abscessus in a Pediatric Intensive Care Unit. In the absence of definite source identification, reinforcement of standard infection control guidelines was successful in containing the outbreak.
Insights
A rare Mycobacterium abscessus outbreak in a Pediatric Intensive Care Unit (PICU) affected five patients. Strict infection control measures successfully contained the respiratory tract infections, even without identifying the exact source.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Mycobacterium abscessus is linked to various infections, but outbreaks are uncommon.
- This study details a rare outbreak of M. abscessus in a healthcare setting.
Purpose of the Study:
- To report and investigate an outbreak of M. abscessus causing respiratory infections in a Pediatric Intensive Care Unit (PICU) in Kuwait.
- To outline the control measures implemented during the outbreak.
Main Methods:
- Respiratory secretions from symptomatic patients were cultured and analyzed.
- Mycobacterium abscessus isolates were identified using molecular methods (line probe assay, DNA sequencing, strain typing).
- Epidemiological investigation and environmental sampling were conducted.
Main Results:
- Five patients were affected, with four experiencing severe infections, including one case of septicemia.
- Asymptomatic carriage of the outbreak strain was identified in one patient.
- The source of the outbreak could not be definitively identified, and environmental samples were negative for M. abscessus.
Conclusions:
- This is the first reported hospital-acquired outbreak of M. abscessus respiratory infection in a PICU.
- Reinforcing standard infection control guidelines was effective in controlling the outbreak despite the unidentified source.
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