573. Detection of a Cluster of Nontuberculous Mycobacteria at a Tuberculosis Hospital: A Quality Assurance Intervention
Session: Poster Abstract Session: TB: Non-Tuberculous Mycobacterial Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Poster_IDSA_10_2_15_final_pdf.pdf (1.3 MB)
  • Background: Non tuberculous mycobacteria (NTM) are widely distributed in soil and water. Texas Center for Infectious Disease (TCID), a hospital for patients with confirmed tuberculosis (TB) and San Antonio Metro Health (SAM), a clinic serving outpatients with suspected or confirmed TB share the same water supply. After a cluster of isolates of Mycobacterium gordonae was noted from patients at TCID, a quality assurance intervention reviewed the protocols for both TCID and SAM.

    Methods: All sputa collected for AFB culture from diagnosed TB patients at TCID and SAM during 2014 were included.  Sputum samples were processed at the Texas Department of State and Health Services (DSHS) Laboratory. Genotyping was performed on available M. gordonae isolates to ascertain relatedness.

    Results: A total of 2053 sputum samples were processed; 1288 (62.74%) from TCID and 765 (37.26%) from SAM. One (0.08%) and 5 (0.65%) from TCID and SAM respectively were contaminated. Only NTM grew from 55 (4.27%) and 21 (2.75%) from TCID and SAM respectively. M. gordonae accounted for 28 of 55 (50.91%) of the NTM at TCID and only 1 of 21 (4.76%) at SAM. No patients had evidence of NTM disease. Review of protocols identified breaches (eating and drinking prior to collection, delays in transport) which may have increased the recovery of NTM. Sterile water was not used to rinse the mouth by either facility.  

    Conclusion: Neither the hospital nor the clinic had adequate protocols. A breach at TCID accounted for the increase in M. gordonae isolates. The percentage of contaminated sputa was lower at TCID and SAM than the DSHS Laboratory average of 1.3%. This may reflect a quicker transport time to the laboratory. In areas where tap water or bottled water contains NTM, the use of sterile water to rinse the mouth prior to collection of sputa should be recommended.

    Quratulain Kizilbash, MD, MPh1, Kenneth Jost, PhD2, Lisa Armitige, MD, PhD3, David E. Griffith, MD4, Denise Dunbar, PhD2, Thomas Schlenker, MD/MPH5 and Barbara Seaworth, MD, FIDSA6, (1)Internal Medicine, University of Texas Health Northeast, San Antonio, TX, (2)Texas Department of State Health Services, Austin, TX, (3)Heartland National Tuberculosis Center, San Antonio, TX, (4)University of Texas Health Sciences Center at Tyler, Tyler, TX, (5)City of San Antonio Metropolitan Health District, San Antonio, TX, (6)Medicine, University of Texas Health Science Center, Tyler, San Antonio, TX

    Disclosures:

    Q. Kizilbash, None

    K. Jost, None

    L. Armitige, None

    D. E. Griffith, None

    D. Dunbar, None

    T. Schlenker, None

    B. Seaworth, None

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