{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:00:16Z","timestamp":1781236816301,"version":"3.54.1"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23002738_as1\"><jats:title>Background:<\/jats:title><jats:p>Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated <jats:italic>M. abscessus<\/jats:italic> (HA-Mab) put in place following a prior institutional outbreak of <jats:italic>M. abscessus<\/jats:italic> alerted investigators to a cluster of 3 extrapulmonary <jats:italic>M. abscessus<\/jats:italic> infections among patients who had undergone cardiothoracic surgery.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23002738_as2\"><jats:title>Methods:<\/jats:title><jats:p>Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of <jats:italic>M. abscessus<\/jats:italic> in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental <jats:italic>M. abscessus<\/jats:italic> isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23002738_as3\"><jats:title>Results:<\/jats:title><jats:p>Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. <jats:italic>M. abscessus<\/jats:italic> was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of <jats:italic>M. abscessus<\/jats:italic> from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23002738_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted <jats:italic>M. abscessus<\/jats:italic> to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.273","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T08:04:17Z","timestamp":1703145857000},"page":"644-650","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["A cluster of three extrapulmonary <i>Mycobacterium abscessus<\/i> infections linked to well-maintained water-based heater-cooler devices"],"prefix":"10.1017","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7117-513X","authenticated-orcid":false,"given":"Jessica L.","family":"Seidelman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0914-0291","authenticated-orcid":false,"given":"Arthur W.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah S.","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7238-0300","authenticated-orcid":false,"given":"Bobby G.","family":"Warren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Barrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Graves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5577-2241","authenticated-orcid":false,"given":"Bonnie","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7329-2820","authenticated-orcid":false,"given":"Jill","family":"Engel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Bonnadonna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Milano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Wallace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Stiegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-5496","authenticated-orcid":false,"given":"Deverick J.","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Becky A.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"S0899823X23002738_ref6","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1093\/cid\/ciaa215","article-title":"Invasive Mycobacterium abscessus complex infection after cardiac surgery: epidemiology, management, and clinical outcomes","volume":"72","author":"Baker","year":"2021","journal-title":"Clin Infect Dis"},{"key":"S0899823X23002738_ref13","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1128\/jcm.33.9.2233-2239.1995","article-title":"Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing","volume":"33","author":"Tenover","year":"1995","journal-title":"J Clin Microbiol"},{"key":"S0899823X23002738_ref14","unstructured":"14. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}