Source of rare bacterial infection at Upstate hospital still being sought

Greenville NewsJune 21, 2014 

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Greenville Health System

Surgical equipment has been implicated in a rare bacterial infection that contributed to the death of one patient and sickened 13 others at Greenville Memorial Hospital over the past three months, officials confirmed Friday.

“We’re not real sure exactly what happened,” said Dr. Bill Kelly, hospital epidemiologist.

“We believe there was a piece of equipment compromised in some way and it has been taken out of service,” he said. “And at this point, we think the measures we’ve taken have managed the situation.”

An investigation that includes the U.S. Centers for Disease Control and Prevention and the state Department of Health and Environmental Control is continuing to identify just how the atypical Mycobacterium abscessus was introduced to the hospital, he said.

There were no breaks in sterility protocols as best officials can determine, he said.

The first infection was traced back to March, Kelly said, adding that officials checked patients from as far back as 18 months once the discovery was made.

Most of the patients had undergone cardiac surgery, while two had abdominal surgery and one a neurological operation, he said. Some are still hospitalized while others have gone home, he said.

It’s still possible that others who had surgery before the contamination was detected could be infected as well, Kelly said. They are all being notified, he said.

Any patients who think they may have contracted the infection should talk with their doctors, all of whom have been apprised of the situation, he said.

One patient who was infected died, but the primary cause of death was an underlying disease, hospital officials said. The investigation was complicated by mycobacterium’s long incubation period — up to two months, Kelly said. So there was a long time between the first infection and when officials recognized what was happening, he said.

Mycobacteria are found in water, soil and elsewhere in the natural environment, officials said.

So in May, in addition to taking the suspect equipment out of use and removing all other equipment potentially involved, only sterile water is being used in surgical processes now, he said.

Kelly said any investigation of water sources would be conducted by DHEC.

A spokesman for DHEC, Jim Beasley, said, “Our role in this continuing investigation is helping Greenville Health System and the CDC determine the source of the infections and prevent further infections. Mycobacteria are naturally occurring. Although mycobacteria rarely cause illness under normal circumstances, people who have recently undergone surgery could be more susceptible to infection.”

According to the CDC, Mycobacterium abscessus has been known to contaminate medications and medical devices. Infections associated with health care settings usually affect the skin and the soft tissues, though it can also cause serious lung infections in people with chronic lung disease, the agency says.

There is little risk of transmission between people, the CDC reports.

Most of the affected patients, all of whom had other health conditions, got infections in their surgical wounds, Kelly said. They are being treated with multiple antibiotics because mycobateria “have an inherent resistance,” he said.

While health officials believe they have traced the infection to the equipment system, which wasn’t identified, the investigation continues to look at all possibilities, he said.

“We still don’t have final answers,” Kelly said. “But we’ve taken an aggressive stance with the infection prevention team and instituted a very robust investigation.”

In July 2012, GHS confirmed that 11 patients may have been exposed to Creutzfeldt-Jakob disease through sterilized surgical instruments at Greenville Memorial that were previously used on a patient later diagnosed with the fatal disease.

Creutzfeldt-Jakob disease, or CJD, is a degenerative neurological condition similar to mad cow disease in which the brain eventually develops holes like a sponge, according to the National Institutes of Health.

The hospital said all the instruments were sterilized according to protocol, but that it wasn’t known at the time of surgery that the patient had CJD and CDC recommends instruments that have come into contact with an organism undergo additional sterilization.

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