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Nosocomial Mycobacterium gordonae Pseudoinfection From Contaminated Ice Machines

Published online by Cambridge University Press:  02 January 2015

Anand P. Panwalker*
Affiliation:
Section of Infectious Diseases, Department of Medicine, Veterans Administration Medical Center and, Thomas Jefferson University, Wilmington, Delaware
Elizabeth Fuhse
Affiliation:
Section of Infectious Diseases, Department of Medicine, Veterans Administration Medical Center and, Thomas Jefferson University, Wilmington, Delaware
*
Veterans Administration Medical Center and, Thomas Jefferson Unwersity, 1601 Kirkwood Highway, Wilmington, DE 19805

Abstract

Thirty-two clinical specimens submitted to the laboratory during a 12-month period from July 1980 to June 1981 were reported to be culture-positive for Mycobacterium gordonae, an organism generally considered to be a slow-growing saprophyte with natural habitats which include soil and water. Only seven similar isolates had been recovered in the preceding year period. The discordance between clinical findings and the mycobacterial cultures suggested extrinsic contamination of the specimens. Contamination in the laboratory was believed unlikely because: 1) clinical samples obtained in an aseptic manner were never contaminated; 2) various surveillance cultures of reagents and deionized water used in the laboratory were negative; and 3) substitution of deionized water with sterile water did not control the outbreak. Extensive hospital-wide cultures of water sources implicated the use of ice and ice water from contaminated ice machines as the source of this pseudoepidemic. Cleaning of the ice machines resulted in a sharp decrease in the number of M. gordonae isolates. Pseudoinfection by M. gordonae from improperly maintained ice machines has not been reported before.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

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