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ISHLT ALERT!
Mycobacterium abscessus:
Yet One More Thing to Worry About in Cystic Fibrosis


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Stanley I Martin, MD
ISHLT Links Associate Editor (Infectious Diseases)
stanley.martin@osumc.edu


At the end of March, researchers from the UK published in The Lancet their findings on genome sequencing among M. abscessus isolates from cystic fibrosis (CF) patients.[1] Battling drug-resistant infections in the respiratory tract of CF patients is nothing new, and non-tuberculous mycobacteria (NTM) have always been a challenge in this group of patients, particularly when thinking about their potential transplantability. The study, done by Cambridge, looked at 168 consecutive isolates of M. abscessus—one of the more drug-resistant and tenacious of the NTM—from 31 CF patients at one center. The researchers performed whole-genome sequencing and found a significant degree of similarity among isolates from different individuals (more so than you often find in any one patient). These data, along with time and environment tracings, strongly suggest a potential common source outbreak and even the possibility of actual person-to-person transmission.

The spread of drug-resistant pathogens in CF is not unique (Burkholderia, for example), but historically TB was the only Mycobacterium thought to be easily transmitted from person-to-person. All NTM are thought to be acquired from environmental sources such as water or soil. These data suggest that common source transmission is a factor and the infection may spread from person-to-person in an indirect fashion in the healthcare setting. This could have obvious implications for infection control measures when our lung transplant recipients and pre-transplant patient care are occurring in close proximity. These findings have prompted the authors to begin screening sputum of all their CF patients for NTM, segregating infected patients within a dedicated outpatient clinic and using negative pressure rooms for inpatient care. Whether these measures will reduce transmission rates, however, remains unclear.



Disclosure Statement: the author has no conflicts of interest to disclose


Dr Martin is an Associate Editor (Infectious Diseases) for the ISHLT Links Newsletter, a member of the ISHLT 2013 Program Committee, and the ISHLT Infectious Diseases Council Standards and Guidelines Committee Workforce Leader. He is an Assistant Professor in the Division of Internal Medicine at The Ohio State University Medical Center.


References:

  1. Bryan JM, Grogono DM, Greaves D, et al. Whole-genome sequencing to identify transmission of Mycobacterium abscessus between patients with cystis fibrosis: a retrospective cohort study. The Lancet 2013; early online publication, 29 March