Mycobacteriosis as a healthcare-associated infection: A review of epidemiologic studies

Introduction: Healthcare-associated infections are of great socio-economic importance and are characterized by a large number of different pathogens. Nontuberculous mycobacteria are ubiquitous microorganisms that can circulate in a medical organization. The purpose of this review of epidemiologic studies was to establish the main features of mycobac-teriosis as a healthcare-associated infection, taking into account the significance of the results and the compliance of the reviewed studies with the criteria of evidence-based medicine. Methods: We did a key word search for “nontuberculous mycobacteria”, “healthcare-associated infections”, and “mycobacteriosis” in several electronic bibliographic databases including Web of Science, PubMed, eLIBRARY, and ResearchGate and selected 127 out of 342 search results. Having analyzed the selected articles, we decided to include 34 of them in this study according to the topic of work. We established that nontuberculous mycobacteria can be found in various objects of health facilities, e.g. water supply systems, medical products and equipment. We also found that mycobacterial infection of nosocomial etiology could have various clinical manifestations (arthritis, keratitis, circulatory and skin diseases, etc.) determined by various aspects, such as heterogeneity of the group of nontuberculous mycobacteria, portals of entry (surgical procedures on various organs and systems of the human body, etc.), pathways of exposure and transmission factors. Resistance of nontuberculous mycobacteria to a number of disinfectants is a special question defining the importance of profound research in terms of ensuring sanitary and anti-epidemic (disinfection) safety within health facilities. Conclusions: Our findings indicate that mycobacterial infection can be considered as a healthcare-associated infection requiring an in-depth assessment from various perspectives including a microbiological monitoring of medical objects, statistical accounting of nosocomial infections, and clinical alertness in the diagnosis of mycobacteriosis by attending physicians and bacteriologists, etc.

микобактериоз, инфекции, связанные с оказанием медицинской помощи, инфекционный контроль, эпидемиологические риски, mycobacteriosis, healthcare-associated infection, infection control, epidemiologic risks

1. Акимкин В.Г., Тутельян А.В. Актуальные направления научных исследований в области инфекций, связанных с оказанием медицинской помощи, на современном этапе // Здоровье населения и среда обитания. 2018. № 4 (301). С. 46-50.

2. Иванова М.В., Миндлина А.Я. Эпидемиологические особенности инфекций, связанных с оказанием медицинской помощи в родовспомогательных учреждениях Российской Федерации в 2007-2017 гг.// Журнал инфектологии. 2019. Т. 11. № 3. С. 90-101.

3. Иванов А.В. Интервью с главным внештатным специалистом эпидемиологом Минздрава России, акад. РАН, проф. Николаем Ивановичем Брико [Текст] // Statuspraesens. Гинекология, Акушерство, Бесплодный Брак. 2017. № 5 (42). С. 47-52.

4. Brown-Elliott B, Wallace RJ Jr. Healthcare-associated outbreaks and pseudo-outbreaks of nontuberculous mycobacteria: a comprehensive approach to diagnosis and management. In: Griffth DE, editor. Nontuberculous mycobacterial disease. Cham, Switzerland: Springer; 2019. P. 483-503. DOI: https://doi.org/10.1007/978-3-319-93473-0_18

5. Petrov IV, Novikova MO, Almukhametov AA, et al. Comparative characteristic of cases of mycrobacteriosis and tuberculosis among HIV-infected patients. Helix. 2017; 8(1):2988-2991. DOI: https://doi.org/10.29042/2018-2988-2991

6. Van Ingen J, Bendien SA, de Lange WC, et al. Clinical relevance of non-tuberculous mycobacteria isolated in the Nijmegen-Arnhem region, the Netherlands. Thorax. 2009; 64(6):502-06. DOI: https://doi.org/10.1136/thx.2008.110957

7. Ziza JM. Lessons in medicine: apropos of a modern epidemic of Mycobacterium xenopi spondylodiscitis. Rev Med Interne. 1997; 18(11):845-8. (In French).

8. Salmon JH, Direz G, Ziza JM, et al. Discitis and sacroiliitis diagnosed 15 years after iatrogenic Mycobacterium xenopi inoculation. Joint Bone Spine. 2012; 79(4):409-11. DOI: https://doi.org/1016/jjbspin.2012.02.001

9. Salliot C, Desplaces N, Boisrenoult P, et al. Arthritis due to Mycobacterium xenopi: A retrospective study of 7 cases in France. Clin Infect Dis. 2006; 43(8):987-93. DOI: https:// doi.org/10.1086/507631

10. Fol M, Olek J, Kowalewicz-Kulbat M, et al. Nontuberculous mycobacteria: M. marinum, M. ulcerans, M. xenopi - brief characteristics of the bacteria and diseases caused by them. Postepy Hig Med Dosw. 2011; 65:574-83. (In Polish). DOI: https://doi.org/10.5604/17322693.958464

11. Rodari P, Marocco S, Buonfrate D, et al. Prosthetic joint infection due to Mycobacterium xenopi: a review of the literature with a new case report. Infection. 2020; 48:165171. DOI: https://doi.org/10.1007/s15010-019-01318-1

12. Feldmann JL, Menkes CJ, Le Charpentier Y, et al. Osteoarthritis of the knee caused by Mycobacterium xenopi. Rev Rhum Mal Osteoartic. 1982; 49(6):459-61. (In French).

13. Kelly M, Thibert L, Sinave C. Septic arthritis in the knee due to Mycobacterium xenopi in a patient undergoing hemodialysis. Clin Infect Dis. 1999; 29(5):1342-3. DOI: https://doi.org/10.1086/313447

14. Jiva TM, Jacoby HM, Weymouth LA, et al. Mycobacterium xenopi: innocent bystander or emerging pathogen? Clin Infect Dis. 1997; 24(2):226-32.

15. Thibert L, Lapierre S. Routine application of high-performance liquid chromatography for identification of mycobacteria. J Clin Microbiol. 1993; 31(7):1759-63.

16. Falkinham JO. Epidemiology of infection by nontuberculous mycobacteria. Clin Microbiol Rev. 1996; 9(2):177-215.

17. Hsu JL, Bhatnagar U, Stys M, et al. M. chimaera: a multiheaded pathogen. S D Med. 2018; 71(6):246-250.

18. Tagashira Y, Kozai Y, Yamasa H, et al. A cluster of central line-associated bloodstream infections due to rapidly growing nontuberculous mycobacteria in patients with hematologic disorders at a Japanese tertiary care center: an outbreak investigation and review of the literature. Infect Control Hosp Epidemiol. 2015; 36(1):76-80. DOI: https://doi.org/10.1017/ ice.2014.14

19. Girgis DO, Karp CL, Miller D. Ocular infections caused by non-tuberculous mycobacteria: update on epidemiology and management. Clin Exp Ophthalmol. 2011; 40(5):467-75 DOI: https://doi.org/10.1111/j.1442-9071.2011.02679.x

20. Covert TC, Rodgers MR, Reyes AL, et al. Occurrence of nontuberculous mycobacteria in environmental samples. Appl Environ Microbiol. 1999; 65(6):2492-6.

21. Kham-Ngam I, Chetchotisakd P, Ananta P, et al. Differentiation between persistent infection/colonization and re-infection/recolonization of Mycobacterium abscessus isolated from patients in Northeast Thailand. Infect Genet Evol. 2019; 68:35-42.

22. Chu HS, Chang SC, Shen EP, et al. Nontuberculous mycobacterial ocular infections - comparing the clinical and microbiological characteristics between Mycobacterium abscessus and Mycobacterium massiliense. PLoS One. 2015; 10(1):e0116236. DOI: https:// doi.org/10.1371/journal.pone.0116236

23. Moorthy RS, Valluri S, Rao NA. Nontuberculous mycobacterial ocular and adnexal infections. Surv Ophthalmol. 2012; 57(3):202-

24. DOI: https://doi.org/10.1016/j.survophthal.2011.10.006

25. Hung JH, Huang YH, Chang TC, et al. A cluster of endophthalmitis caused by Mycobacterium abscessus after cataract surgery. J Microbiol Immunol Infect. 2016; 49(5):799-803. DOI: https://doi.org/10.1016/j.jmii.2014.02.001

26. Paulose RM, Joseph J, Narayanan R, et al. Clinical and microbiological profile of non-tuberculous mycobacterial endophthalmitis - experience in a tertiary eye care centre in Southern India. J Ophthal Inflamm Infect. 2016; 6, 27. DOI: 10.1186/s12348-016-0096-x

27. Baker AW, Lewis SS, Alexander BD, et al. Two-phase hospital-associated outbreak of Mycobacterium abscessus: investigation and mitigation. Clin Infect Dis. 2017; 64(7):902-

28. DOI: https://doi.org/10.1093/cid/ciw877

29. Longworth SA, Vinnard C, Lee I, et al. Risk factors for nontuberculous mycobacterial infections in solid organ transplant recipients: a case-control study. Transpl Infect Dis. 2014; 16(1):76-83.

30. Iroh Tam PY, Kline S, Wagner JE, et al. Rapidly growing mycobacteria among pediatric hematopoietic cell transplant patients traced to the hospital water supply. Pediatr Infect Dis J. 2014; 33(10):1043-6.

31. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016; 387(10021):882-93.

32. Sax H, Bloemberg G, Hasse B, et al. Prolonged outbreak of Mycobacterium chimaera infection after open-chest heart surgery. Clin Infect Dis. 2015; 61(1):67-75.

33. Sommerstein R, Hasse B, Widmer AF. Invasive Mycobacterium chimaera infections and heater - cooler devices in cardiac surgery. Emerg Infect Dis. 2020; 26(3):632-633.

34. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175(4):367-416. DOI: https://doi. org/10.1164/rccm.200604-571ST

35. Chand M, Lamagni T, Kranzer K, et al. Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. Clin Infect Dis. 2017; 64(3):335-42. DOI: https:// doi.org/10.1093/cid/ciw754

36. Hannah CE, Ford BA, Chung J, et al. Characteristics of nontuberculous mycobacterial infections at a Midwestern Tertiary Hospital: A retrospective study of 365 patients. Open Forum Infect Dis. 2020; 7(6):ofaa173. DOI: https:// doi.org/10.1093/ofid/ofaa173.