Methods: We reviewed all laboratory-confirmed NTM isolates from non-pulmonary sites reported by electronic laboratory reporting January 1, 2014–May 22, 2015. Case interviews collected epidemiologic risk factors and exposures for NTM infection (e.g., surgery, tattoos, etc). Clusters were defined as ≥2 NTM isolates of the same species with an epidemiologic link; or by facility reporting.
Results: We identified 65 isolates of non-pulmonary NTM: 24 (37%) Mycobacterium avium complex, 17 (26%) M. fortuitum, 12 (18%) M. abscessus/chelonae. Cases were aged 1–88 (median 55) years; 34 (53%) female, and 25 (39%) were hospitalized at the time of diagnosis. Isolates sources were tissue (18), wound (16), blood (9), joint (7), lymph node (5), skin (3), urine (2), abscess (1), bone (1), catherter tip (1), peritoneal fluid (1), and unknown (1). Three clusters were identified: (1) 7 M. fortuitum associated with prosthetic joint replacement surgery; (2) 2 M. fortuitum associated with abdominoplasty in an ambulatory surgery center (ASC); and (3) 2 M. hemophilum associated with a tattoo parlour. Identification of cluster (1) relied on regional infection preventionists’ report because surgeries occurred at 4 different hospitals. Investigation revealed poor infection control practice by vendor representatives; infection with M. fortuitum was associated with the presence of a vendor representative during joint prosthesis surgery (mOR: 32.4, 95%CI: 6.3–∞; P = 0.0001). The representative reported daily hot tub use prior to work in operating rooms. Investigations of the ASC and tattoo parlour are ongoing.
Conclusion: NTM laboratory surveillance for non-pulmonary isolates can identify clusters from common sources if sufficient detail is collected on case interview and medical chart review (e.g., name of surgeon, tattoo parlour, spa) entered into searchable fields. Cluster reporting by healthcare providers remains key to the identification of healthcare-associated NTM outbreaks.
G. L. Buser,
M. R. Laidler, None
P. R. Cieslak, None
Z. G. Beldavs, None