TY - JOUR
T1 - Mycobacterium xenopi spinal infections after discovertebral surgery
T2 - Investigation and screening of a large outbreak
AU - Astagneau, Pascal
AU - Desplaces, Nicole
AU - Vincent, Véronique
AU - Chicheportiche, Valérie
AU - Botherel, Anne Hélène
AU - Maugat, Sylvie
AU - Lebascle, Karine
AU - Léonard, Philippe
AU - Desenclos, Jean Claude
AU - Grosset, Jacques
AU - Ziza, Jean Marc
AU - Brücker, Gilles
N1 - Funding Information:
We thank the members of the expert group: M Aggoune, E Cambau, P Chazerain, B Decludt, S Dubrou, V Jarlier, J-D Laredo, M Lequellec-Nathan, P Mamoudy, C Perronne, G Saillant, C Truffot-Pernot, P Vallée, P Vinceneux, V Vuillemin, and M Wybier. We also thank T Tran-Minh, C Gobé, and D Fauvet for their contribution to the data management, P Duneton for his contribution during the first investigation, and Prof J Ménard for his helpful comments. This study was supported by grants from the Ministry of Health and the Institut de Veille Sanitaire. Preliminary results were presented at the 9th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, April, 1999, San Francisco, USA
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2001/9/1
Y1 - 2001/9/1
N2 - Background: Mycobacterium xenopi spinal infections were diagnosed in 1993 in patients who had undergone surgical microdiscectomy for disc hernia, by nucleotomy or microsurgery, in a private hospital. Contaminated tap water, used for rinsing surgical devices after disinfection, was identified as the source of the outbreak. Several cases were recorded in the 4 years after implementation of effective control measures because of the long time between discectomy and case detection. The national health authorities decided to launch a retrospective investigation in patients who were exposed to M xenopi contamination in that hospital. Methods: Mailing and media campaigns were undertaken concurrently to trace exposed patients for spinal infections. Patients were screened by magnetic resonance imaging (MRI), and the scans were reviewed by a radiologist who was unaware of the diagnosis. Suspected cases had discovertebral biopsy for histopathological and bacteriological examination. Findings: Of 3244 exposed patients, 2971 (92%) were informed about the risk of infection and 2454 (76%) had MRI. Overall, 58 cases of M xenopi spinal infection were identified (overall cumulative frequency 1.8%), including 26 by the campaign (mean delay in detection 5.2 years, SD 2.4, range 1-10 years). Multivariate analysis showed that the risk of M xenopi spinal infection was related to nucleotomy and high number of patients per operating session. Interpretation: Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly and receive effective information.
AB - Background: Mycobacterium xenopi spinal infections were diagnosed in 1993 in patients who had undergone surgical microdiscectomy for disc hernia, by nucleotomy or microsurgery, in a private hospital. Contaminated tap water, used for rinsing surgical devices after disinfection, was identified as the source of the outbreak. Several cases were recorded in the 4 years after implementation of effective control measures because of the long time between discectomy and case detection. The national health authorities decided to launch a retrospective investigation in patients who were exposed to M xenopi contamination in that hospital. Methods: Mailing and media campaigns were undertaken concurrently to trace exposed patients for spinal infections. Patients were screened by magnetic resonance imaging (MRI), and the scans were reviewed by a radiologist who was unaware of the diagnosis. Suspected cases had discovertebral biopsy for histopathological and bacteriological examination. Findings: Of 3244 exposed patients, 2971 (92%) were informed about the risk of infection and 2454 (76%) had MRI. Overall, 58 cases of M xenopi spinal infection were identified (overall cumulative frequency 1.8%), including 26 by the campaign (mean delay in detection 5.2 years, SD 2.4, range 1-10 years). Multivariate analysis showed that the risk of M xenopi spinal infection was related to nucleotomy and high number of patients per operating session. Interpretation: Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly and receive effective information.
UR - http://www.scopus.com/inward/record.url?scp=0035448584&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035448584&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(01)05843-3
DO - 10.1016/S0140-6736(01)05843-3
M3 - Article
C2 - 11551599
AN - SCOPUS:0035448584
SN - 0140-6736
VL - 358
SP - 747
EP - 751
JO - Lancet
JF - Lancet
IS - 9283
ER -