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An Outbreak of Mycobacterium abscessus Infection in a Pediatric Intensive Care Unit in Kuwait

Jamal, Wafaa MD, PhD, FRCPath*†‡; Salama, Mona F. MD, PhD‡§; Al Hashem, G. MD, FRCPath; Rifaei, M. MD; Eldeen, H. MD; Husain, Entesar H. MD, FRCP(C); Ahmad, S. PhD*; Rotimi, Vincent O. MD, PhD, FRCPath*†‡

The Pediatric Infectious Disease Journal: March 2014 - Volume 33 - Issue 3 - p e67–e70
doi: 10.1097/INF.0000000000000071
Original Studies

Background: Mycobacterium abscessus has been associated with respiratory tract infections, localized skin and soft tissue infections and sepsis. However, outbreaks of M. abscessus are rare.

Aim: to report an outbreak of M. abscessus causing respiratory tract infections in a Pediatric Intensive Care Unit (PICU) in Kuwait, its investigation and control measures.

Methods: Respiratory secretions were obtained from ventilator-dependent patients showing signs of sepsis, including fever, malaise and weight loss. The specimens were cultured on appropriate routine media. After the results of the sample taken from the index case as acid-fast bacilli positive, all patients were screened for M. abscessus carriage. Isolates were identified by INNO-LiPA Mycobacteria v2 line probe assay and DNA sequencing. Molecular fingerprinting DiversiLab strain typing was performed on the isolates. Epidemiologic investigation was conducted during the outbreak.

Findings: the outbreak affected 5 patients, 4 of whom had severe infections including 1 patient with septicemia. Asymptomatic carriage of outbreak strain was found in 1 patient. All environmental samples were negative for M. abscessus but some were positive for M. gordonae and M. fortuitum. The source could not be identified. Stringent infection control measures were put in place, including reemphasizing hand hygiene and closure of the Pediatric Intensive Care Unit to new admissions. A year later, no further case has occurred after the last case.

Conclusion: To our knowledge, this is the first report of a hospital-acquired outbreak of respiratory tract infection caused by M. abscessus in a Pediatric Intensive Care Unit. In the absence of definite source identification, reinforcement of standard infection control guidelines was successful in containing the outbreak.

From the * Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait; Microbiology Unit; Infection Control Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; § Microbiology and Immunology Department, Mansoura Faculty of Medicine, Mansoura, Egypt; Pediatric Department, Mubarak Al Kabeer Hospital, Jabriya; and National TB Reference Laboratory, Shuweikh, Kuwait.

Accepted for publication September 4, 2013.

W.J. is a member of the Regional Advisory Board of Astellas.

The authors have no funding or conlflicts of interest to disclose.

Address for correspondence: Dr Wafaa Jamal, MD, PhD, FRCPath, Department of Medicine, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat 13110, Kuwait. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.