1782. Pediatric Dental Clinic Associated-Outbreak of Mycobacterium abscessus Infections
Session: Oral Abstract Session: Children Getting Sick from Healthcare Pediatric HAIs
Saturday, October 29, 2016: 11:15 AM
Room: 275-277
Background: Invasive infections attributed to Mycobacterium abscessus (MAB) among children following dental procedures have not been reported.

Methods: We defined a probable case of dental clinic-associated MAB infection as a child with facial or neck swelling and biopsy-confirmed granulomatous inflammation, following a pulpotomy from 10/01/2013–09/30/2015 at Dental Practice A. Confirmed cases had MAB isolated from clinical specimens. Active case finding was conducted by the state health department in collaboration with clinicians and representatives from Dental Practice A. Clinical course was abstracted from medical records.

Results: Of 23 children, 13 (57%) were confirmed and 10 (43%) were probable cases. Median age was 7 years, (range 3-11) and median time from pulpotomy to symptom onset was 64 days (range 18-139). Manifestations included submandibular or cervical lymphadenopathy in 21/23, mandibular or maxillary osteomyelitis in 13/23, and pulmonary nodules in 7/17. All had >1 hospitalization with median length of stay 8 days (range 3-19), and median of 2 surgeries (range 1-6). Eleven (48%) had complete surgical excision, 11 (48%) received intravenous antibiotics, 1 (4%) received oral antibiotic monotherapy, and 11 (92%) completed >12 weeks of therapy. Seventeen (74%) had a suspected complication related to management: permanent tooth loss 13/23, central venous access malfunction 7/11, aminoglycoside associated high-frequency hearing loss 5/9, an adverse drug reaction 5/12, transient facial nerve palsy 4/21, incision dehiscence/fibrosis 2/23, acute kidney injury 2/11, and drug induced neutropenia 1/11. An epidemiological investigation confirmed 22 (96%) pulpotomies were performed at a single office affiliated with Dental Practice A. Patient and environmental isolates from the dental-chair water supply were identical by pulsed-field gel electrophoresis.

Conclusion: A community outbreak of a MAB contaminated dental water source lead to a prolonged exposure period. Challenges resulted from identification and management with an extended incubation period and varying clinical manifestations. Experience from this outbreak should be applied to guidance related to identification, management, and prevention of similar infections.

Lindsay Hatzenbuehler, MD, MPH1, Cherie Drenzek, MS, DVM2, Melissa Tobin-D'angelo, MD, MPH2, Gianna Peralta, MPH2, Evan J. Anderson, MD3, Jumi Yi, MD1, Craig Shapiro, MD1, Shelly Abramowicz, DMD, MPH4, Lisa Cranmer, MD, MPH1, Steve Shore, MD5, Melissa Statham, MD6, Joseph Hilinski, MD1, Paula Harmon, MD6, Sivi Baktha, MD6, Joseph Williams, MD7, Frank Berkowitz, MD, MPH1, Sarah Milla, MD8, Verlia Gower, MD6, Matthew Whitley, MD6 and Andi L. Shane, MD, MPH, MSc, FIDSA, FPIDS1, (1)Pediatrics, Emory University School of Medicine, Atlanta, GA, (2)Georgia Department of Community Health, Atlanta, GA, (3)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (4)Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, (5)Pediatric Infectious Disease, Children's Healthcare of Atlanta, Atlanta, GA, (6)Ear, Nose and Throat, Children's Healthcare of Atlanta, Atlanta, GA, (7)Plastic and Craniofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, (8)Radiology, Children's Healthcare of Atlanta, Atlanta, GA

Disclosures:

L. Hatzenbuehler, None

C. Drenzek, None

M. Tobin-D'angelo, None

G. Peralta, None

E. J. Anderson, None

J. Yi, None

C. Shapiro, None

S. Abramowicz, None

L. Cranmer, None

S. Shore, None

M. Statham, None

J. Hilinski, None

P. Harmon, None

S. Baktha, None

J. Williams, None

F. Berkowitz, None

S. Milla, None

V. Gower, None

M. Whitley, None

A. L. Shane, None

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