OUTBREAK OF NON-TUBERCULOUS MYCOBACTERIAL INFECTION IN SURGICAL WARD OF A TERTIARY CARE HOSPITAL

*Dr. Rajdeep Saha, MD, Dr. Apoorbaa Roy, Dr. Dipika Menon Mukherjee and Dr. Rajyasri Guha Thakurta, MD

ABSTRACT

Mycobacterium abscessus (M. abscessus) is a rapidly growing mycobacterial species which are ubiquitous in the environment and cause widespread infections. The incidence of these infections increased in recent decades and is of particular public health concern as nosocomial pathogens. This study was conducted to isolate and identify Non-Tuberculous Mycobacteria (NTM) from wound swab sample from post-operative surgical site infection along with finding out the source of infection and forming a treatment protocol for prevention of the same. 411 samples were collected. These samples were subjected to Gram Staining, Ziehl-Neelsen Staining and inoculating on culture plates containing Blood Agar, MacConkey Agar and Lowenstein-Jensen Media. The ZN stain done from the growth as well as the direct swab sample collected from the patients portrayed the presence of Acid Fast Bacilli. The isolated strains were further confirmed by PCR. Swab from OT instruments, trolleys, surgical gowns and other environmental samples and water from the boiler and copper drum was taken for determining the source of infection. Here too the isolates were sent for PCR for identification. 332 out of 411 patients were suffering from NTM infections. The PCR result confirmed it to be Mycobacterium abscessus. The samples collected to determine the source of infection revealed that the infection was due to inadequate sterilisation of boiler water which contaminated the surgical site. Disinfection protocol and antibiotic stewardship was prepared after several meetings. The patients were cured using Clarithromycin 500mg BD for 6 months.

Keywords: Mycobacterium abscessus, Surgical site infection, PCR, Antibiotic stewardship.