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595 Outbreak of Mycobacterium goodii Surgical Site Infections — Midwest Region, 2007–2009

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Parvathy Pillai, MD, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Margaret M. Williams, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Heather O'Connell, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Barbara A. Brown-Elliott, MS, MT(ASCP)SM , University of Texas Health Science Center, Tyler, TX
Steven McNulty, BS , University of Texas Health Science Center, Tyler, TX
Maria McGlasson , University of Texas Health Science Center, Tyler, TX
Linda B. Mann, BS , University of Texas Health Science Center, Tyler, TX
Ravikiran Vasireddy, MBIOT , University of Texas Health Science Center, Tyler, TX
Richard J. Wallace Jr., MD , University of Texas Health Science Center, Tyler, TX
Bryan F. Buss, DVM, MPH, DACVPM , Centers for Disease Control and Prevention, Atlanta, GA

Background: Mycobacterium goodii is a rapidly growing nontuberculosis mycobacterium. Although reports of surgical site infections (SSIs) secondary to M. goodii have been reported, it has rarely been identified as a cause of outbreaks. We report an outbreak of seven M. goodii SSIs occurring during an 18-month period within one Midwestern healthcare facility (HCF X).

Objective: To identify the source of the outbreak and to prevent future cases.

Methods: An outbreak case was defined as any M. goodii SSI reported during the investigation period (November 1, 2007–August 20, 2009) and occurring within 16 weeks after a surgical procedure performed at HCF X. Area laboratories and physicians were contacted for additional case ascertainment. Chart review was performed to collect case data. Operating room (OR) and infection control personnel were interviewed, and body culture samples were obtained from one OR staff member. Environmental cultures were also obtained. All recovered M. goodii isolates were typed by pulsed-field gel electrophoresis (PFGE).

Results: Seven M. goodii SSIs were reported by infection-control practitioners at HCF X during the investigation period; these were the first M. goodii SSIs reported at this facility, and PFGE typing of the corresponding isolates demonstrated indistinguishable patterns. Case ascertainment did not identify additional cases. Surgeries occurred during November 2007–April 2009. Mean duration of surgery was approximately 2 hours. Five cases (71%) involved a surgical implant, but each involved a different device. Four cases (57%) occurred after plastic surgery procedures, but no suture material or surgical pack were in common among the cases. Two procedures (29%) occurred in the same surgical suite, but all others occurred in different surgical suites across four separate surgical areas. No water or ventilation sources were in common among all cases; three separate recovery areas had been used. A total of 44 healthcare workers (HCWs) were present during the surgeries; one (HCW A) was present for a portion of all seven cases. HCW A is an anesthesiologist and reported no history of chronic cough or respiratory or skin conditions. HCW A had been in practice >10 years and reported no changes in professional or personal habits preceding the outbreak. During the investigation period, HCW A was present for 2,215 surgical procedures (M. goodii SSI attack rate: 0.32%). Body-surface cultures from HCW A and environmental cultures from multiple water sources around and in HCW A's home were negative for M. goodii.

Conclusions: This report demonstrates M. goodii's potential to cause SSI outbreaks. The only commonality in this outbreak was an anesthesiologist, but no clear mechanism of transmission was identified. Ongoing surveillance for additional cases of M. goodii SSI at HCF X is warranted.