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Bronchoscopy-associated Mycobacterium xenopi pseudoinfections
S N Bennett1, D E Peterson, D R Johnson
1Division of Field Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
Summary
Mycobacterium xenopi, a rare bacterium, was frequently isolated from bronchoscopy specimens due to contamination from hospital water systems during cleaning. Proper disinfection and specimen collection are crucial to prevent pseudoinfections and transmission.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Mycobacterium xenopi is an uncommon cause of mycobacterial infections, typically representing less than 0.3% of clinical isolates.
- An increased isolation rate of Mycobacterium xenopi was observed in a Michigan hospital over a 37-month period.
Purpose of the Study:
- To investigate the source and characteristics of Mycobacterium xenopi isolates.
- To determine factors associated with Mycobacterium xenopi isolation during bronchoscopy procedures.
- To assess the role of bronchoscopy cleaning and hospital water systems in M. xenopi contamination.
Main Methods:
- Review of hospital, laboratory, and bronchoscopy records.
- Case-control study to identify risk factors for M. xenopi isolation.
- Culturing of hospital water systems and bronchoscopes before and after disinfection.
Main Results:
- Mycobacterium xenopi accounted for 35% of mycobacterial isolates during the study period.
- Bronchoscopy specimens were significantly more likely to yield M. xenopi than other specimen types (RR 9.7).
- M. xenopi was isolated from the hospital's hot water tank and from bronchoscopes after standard disinfection procedures.
Conclusions:
- Hospital tap water, specifically from the hot water system, was identified as the source of M. xenopi contamination.
- Contamination of bronchoscopes during the cleaning process led to pseudoinfections and potential disease transmission.
- Enhanced disinfection protocols for bronchoscopes and meticulous specimen collection are necessary to mitigate M. xenopi-related diagnostic errors and transmission risks.