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Mycobacterium simiae Outbreak Associated With a Hospital Water Supply

Published online by Cambridge University Press:  02 January 2015

Nicholas G. Conger ,
Robert J. O'Connell ,
Valerie L. Laurel ,
Kenneth N. Olivier ,
Edward A. Graviss ,
Natalie Williams-Bouyer ,
Yansheng Zhang ,
Barbara A. Brown-Elliott  and
Richard J. Wallace Jr.
Nicholas G. Conger*
Affiliation:
Department of Infectious Disease, Wilford Hall Medical Center, Lackland AFB, Texas
Robert J. O'Connell
Affiliation:
Department of Infectious Disease, Wilford Hall Medical Center, Lackland AFB, Texas
Valerie L. Laurel
Affiliation:
Department of Infectious Disease, Wilford Hall Medical Center, Lackland AFB, Texas
Kenneth N. Olivier
Affiliation:
Department of Infectious Disease, Wilford Hall Medical Center, Lackland AFB, Texas
Edward A. Graviss
Affiliation:
Departments of Pathology and Medicine, Baylor College of Medicine, Houston, Texas
Natalie Williams-Bouyer
Affiliation:
Departments of Pathology and Medicine, Baylor College of Medicine, Houston, Texas
Yansheng Zhang
Affiliation:
Department of Microbiology, The University of Texas Health Center, Tyler, Texas
Barbara A. Brown-Elliott
Affiliation:
Department of Microbiology, The University of Texas Health Center, Tyler, Texas
Richard J. Wallace Jr.
Affiliation:
Department of Microbiology, The University of Texas Health Center, Tyler, Texas
*
Wilford Hall Medical Center, Infectious Disease, 59 MDW, 2200 Bergquist Drive, Suite 1, Lackland AFB, TX 78236-5300
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Abstract

Objective:

Mycobacterium simiae is found primarily in the southwestern United States, Israel, and Cuba, with tap water as its suspected reservoir. Our institution saw an increase in M. simiae isolates in 2001. An investigation into possible contaminated water sources was undertaken.

Design:

Environmental cultures were performed from water taps in the microbiology laboratory, patient rooms, points in the flow of water to the hospital, and patients' homes. Patient and environmental M. simiae were compared by PFGE.

Setting:

Military treatment facility in San Antonio, Texas.

Patients:

All patients with cultures positive for M. simiae between January 2001 and April 2002. Medical records were reviewed.

Results:

M. simiae was recovered from water samples from the hospital, patients' home showers, and a well supplying the hospital. A single PFGE clone was predominant among water isolates (9 of 10) and available patient isolates (14 of 19). There was an association between exposure to hospital water and pulmonary samples positive for the clonal M. simiae strain (P = .0018). Only 3 of 22 culture-positive patients met criteria for M. simiae pulmonary disease. Of them, two had indistinguishable M. simiae strains from tap water to which they were routinely exposed.

Conclusions:

This represents an outbreak of M. simiae colonization with one nosocomial infection. It is only the second time that M. simiae has been recovered from hospital tap water and its first presentation in municipal water. This study raises issues about the need and feasibility of eliminating or avoiding exposure to M. simiae from tap water.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 12 , December 2004 , pp. 1050 - 1055
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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