Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 23;71(7):e178-e185.
doi: 10.1093/cid/ciz1120.

Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018

Sarah M Labuda  1   2 , Kelley Garner  2 , Michael Cima  2 , Heather Moulton-Meissner  3 , Alison Laufer Halpin  3   4 , Nadege Charles-Toney  3 , Peter Yu  5 , Erin Bolton  5 , Reid Pierce  5 , Matthew B Crist  3 , Danica Gomes  3 , Paige Gable  3 , Gillian McAllister  3 , Adrian Lawsin  3 , Hollis Houston  3 , Naveen Patil  2 , J Gary Wheeler  2 , Robert Bradsher  6 , Keyur Vyas  6 , Dirk Haselow  2
Affiliations

Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018

Sarah M Labuda et al. Clin Infect Dis. .

Abstract

Background: In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections.

Methods: ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness.

Results: By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March-12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P < .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended.

Conclusions: Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH's reportable disease list and providing more oversight to outpatient oncology clinics.

Keywords: healthcare-associated infections; nontuberculous mycobacteria; outbreak investigation.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Number of patients presenting symptomatically with positive blood culture for Mycobacterium FVL 201832 by date, May–October 2018. Epidemic curve of 23 symptomatic cases by date (shown as month/day/year) of first positive blood culture.
Figure 2.
Figure 2.
Dates of exposures, onset of symptoms, and positive cultures in the affected 52 patients.
Figure 3.
Figure 3.
Phylogenetic tree from SNVPhyl. Scale is average substitutions per site.
See this image and copyright information in PMC

References

    1. Halpern MT, Yabroff KR. Prevalence of outpatient cancer treatment in the united states: estimates from the medical panel expenditures survey (MEPS). Cancer Invest 2009; 26:647–51. - PubMed
    1. Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol 2009; 10:589–97. - PubMed
    1. Maschmeyer G, Haas A. The epidemiology and treatment of infections in cancer patients. Int J Antimicrob Agents 2008; 31:193–7. - PubMed
    1. American Cancer Society. Facts and figures 2019. Atlanta, GA: American Cancer Society, 2019.
    1. United States Pharmacopeia Compounding Expert Committee. General chapter pharmaceutical compounding—sterile preparations. USP. 2018. Available at: http://www.usp.org/compounding/general-chapter-797. Accessed 9 January 2019.