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Marshall KE, Free RJ, Filardo TD, Schwartz NG, Hernandez-Romieu AC, Thacker TC, Lehman KA, Annambhotla P, Dupree PB, Glowicz JB, Scarpita AM, Brubaker SA, Czaja CA, Basavaraju SV. Incomplete tissue product tracing during an investigation of a tissue-derived tuberculosis outbreak. Am J Transplant 2024; 24:115-122. [PMID: 37717630 DOI: 10.1016/j.ajt.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
In the United States, there is currently no system to track donated human tissue products to individual recipients. This posed a challenge during an investigation of a nationwide tuberculosis outbreak that occurred when bone allograft contaminated with Mycobacterium tuberculosis (Lot A) was implanted into 113 patients in 18 US states, including 2 patients at 1 health care facility in Colorado. A third patient at the same facility developed spinal tuberculosis with an isolate genetically identical to the Lot A outbreak strain. However, health care records indicated this patient had received bone allograft from a different donor (Lot B). We investigated the source of this newly identified infection, including the possibilities of Lot B donor infection, product switch or contamination during manufacturing, product switch at the health care facility, person-to-person transmission, and laboratory error. The findings included gaps in tissue traceability at the health care facility, creating the possibility for a product switch at the point of care despite detailed tissue-tracking policies. Nationally, 6 (3.9%) of 155 Lot B units could not be traced to final disposition. This investigation highlights the critical need to improve tissue-tracking systems to ensure unbroken traceability, facilitating investigations of recipient adverse events and enabling timely public health responses to prevent morbidity and mortality.
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Affiliation(s)
- Kristen E Marshall
- Colorado Department of Public Health and Environment, Denver, Colorado, USA; Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | - Rebecca J Free
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas D Filardo
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Noah G Schwartz
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alfonso C Hernandez-Romieu
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tyler C Thacker
- National Veterinary Services Laboratories, Veterinary Services, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, Iowa, USA
| | - Kimberly A Lehman
- National Veterinary Services Laboratories, Veterinary Services, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, Iowa, USA
| | - Pallavi Annambhotla
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter B Dupree
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Janet Burton Glowicz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann M Scarpita
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Scott A Brubaker
- Division of Human Tissues, Office of Cellular Therapy and Human Tissue CMC, Office of Therapeutic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Schwartz NG, Hernandez-Romieu AC, Annambhotla P, Filardo TD, Althomsons SP, Free RJ, Li R, Wilson WW, Deutsch-Feldman M, Drees M, Hanlin E, White K, Lehman KA, Thacker TC, Brubaker SA, Clark B, Basavaraju SV, Benowitz I, Burton Glowicz J, Cowan LS, Starks AM, Bamrah Morris S, LoBue P, Stewart RJ, Wortham JM, Haddad MB. Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report. THE LANCET. INFECTIOUS DISEASES 2022; 22:1617-1625. [PMID: 35934016 PMCID: PMC9605268 DOI: 10.1016/s1473-3099(22)00425-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mycobacterium tuberculosis transmission through solid organ transplantation has been well described, but transmission through transplanted tissues is rare. We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor. METHODS In this outbreak report, we describe the management and severity of the outbreak and identify opportunities to improve tissue transplant safety in the USA. During early June, 2021, the US Centers for Disease Control and Prevention (CDC) worked with state and local health departments and health-care facilities to locate and sequester unused units from the recalled lot and notify, evaluate, and treat all identified product recipients. Investigators from CDC and the US Food and Drug Administration (FDA) reviewed donor screening and tissue processing. Unused product units from the recalled and other donor lots were tested for the presence of M tuberculosis using real-time PCR (rt PCR) assays and culture. M tuberculosis isolates from unused product and recipients were compared using phylogenetic analysis. FINDINGS The tissue donor (a man aged 80 years) had unrecognised risk factors, symptoms, and signs consistent with tuberculosis. Bone was procured from the deceased donor and processed into 154 units of bone allograft product containing live cells, which were distributed to 37 hospitals and ambulatory surgical centres in 20 US states between March 1 and April 2, 2021. From March 3 to June 1, 2021, 136 (88%) units were implanted into 113 recipients aged 24-87 years in 18 states (some individuals received multiple units). The remaining 18 units (12%) were located and sequestered. 87 (77%) of 113 identified product recipients had microbiological or imaging evidence of tuberculosis disease. Eight product recipients died 8-99 days after product implantation (three deaths were attributed to tuberculosis after recognition of the outbreak). All 105 living recipients started treatment for tuberculosis disease at a median of 69 days (IQR 56-81) after product implantation. M tuberculosis was detected in all eight sequestered unused units tested from the recalled donor lot, but not in lots from other donors. M tuberculosis isolates from unused product and recipients were more than 99·99% genetically identical. INTERPRETATION Donor-derived transmission of M tuberculosis via bone allograft resulted in substantial morbidity and mortality. All prospective tissue and organ donors should be routinely assessed for tuberculosis risk factors and clinical findings. When these are present, laboratory testing for M tuberculosis should be strongly considered. FUNDING None.
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Affiliation(s)
- Noah G Schwartz
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Alfonso C Hernandez-Romieu
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pallavi Annambhotla
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas D Filardo
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandy P Althomsons
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca J Free
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruoran Li
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Wyatt Wilson
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly Deutsch-Feldman
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Emily Hanlin
- Delaware Department of Health and Social Services, Division of Public Health, Dover, DE, USA
| | - Kelly White
- Indiana Department of Health, Indianapolis, IN, USA
| | - Kimberly A Lehman
- National Veterinary Services Laboratories, Veterinary Services, Animal and Plant Health Inspection Service, US Department of Agriculture, Ames, IA, USA
| | - Tyler C Thacker
- National Veterinary Services Laboratories, Veterinary Services, Animal and Plant Health Inspection Service, US Department of Agriculture, Ames, IA, USA
| | - Scott A Brubaker
- Division of Human Tissues, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Brychan Clark
- Division of Human Tissues, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isaac Benowitz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Burton Glowicz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren S Cowan
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela M Starks
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sapna Bamrah Morris
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip LoBue
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebekah J Stewart
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan M Wortham
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maryam B Haddad
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Khodadadi M, Allahdadian M, Mohammadi Sichani M. Isolation, Characterization, and Molecular Identification of Mycoplasma hominis in Females With Bacterial Vaginosis and its Association With Epidemiological Factors: A Cross-sectional Study From Isfahan Province, Iran. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2021. [DOI: 10.34172/ijep.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Mycoplasma strains are frequently found in the human urogenital tract and are mainly associated with bacterial vaginosis (BV) which has several adverse outcomes including infertility, preterm delivery, and abortion. The prevalence of BV caused by Mycoplasma species could be associated with different epidemiological factors such as ethnicity, socioeconomic status, sexual activity, and age. Objective: This study aimed to investigate the prevalence of BV caused by Mycoplasma hominis and to examine its association with several epidemiological factors. Materials and Methods: A total number of 110 married, non-pregnant women in the 18-45 age range and with BV referring to the healthcare centers of Falavarjan, Isfahan province, Iran were included in this study. BV was diagnosed based on the Amsel criteria, and the polymerase chain reaction (PCR) was used for detecting M. hominis. Then, the association of several epidemiologic factors with the presence of M. hominis was examined. Results: According to the study results, 15.4% of patients (group 1, n=17) were positive for M. hominis infection, while the remaining ones (group 2, n=93) were negative for this pathogen. Statistical analyses showed no significant difference between the two groups in terms of age range, job, education level of the subjects and their husbands, history of birth delivery and abortion, number of sexual intercourses per week, daily vaginal wash, body mass index (BMI), socioeconomic status, contraception method, and positive whiff test. However, a higher prevalence of M. hominis infection was observed among the women with previous deliveries ≥2, which was significantly different from the prevalence of non-M. hominis infection. Moreover, a significant association of M. hominis infection with the pH of vaginal discharge and presence of clue cells was detected. Conclusion: An association was found between M. hominis infection and previous deliveries among the studied women, while other epidemiological factors were discovered not to be important determinants in this regard.
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Affiliation(s)
- Maedeh Khodadadi
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Maryam Allahdadian
- Department of Midwifery, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
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Wang N, Liu W, Zhou Y, Liu Y. In vitro Activities of Nemonoxacin and Other Antimicrobial Agents Against Human Mycoplasma and Ureaplasmas Isolates and Their Defined Resistance Mechanisms. Front Microbiol 2019; 10:1890. [PMID: 31456791 PMCID: PMC6700270 DOI: 10.3389/fmicb.2019.01890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023] Open
Abstract
Nemonoxacin, a newly developed non-fluorinated quinolone (NFQ), selectively inhibits bacterial DNA topoisomerase activity. However, its activities against Mycoplasmas have rarely been studied to date. Herein, the activities of nemonoxacin were evaluated against clinical isolates of 50 Mycoplasma pneumoniae, 20 Mycoplasma hominis, and 77 Ureaplasma spp., and they were compared to fluoroquinolones, tetracyclines, and macrolides. Nemonoxacin MICs (μg/ml) ranged from 0.03 to 0.25 for M. pneumoniae, 0.25 to 8 for M. hominis, and 0.06 to >16 for Ureaplasma spp., and all of the ranges are similar to those of fluoroquinolones. The activity of nemonoxacin against Mycoplasmas was not affected by resistance to macrolides in the strains tested, but it seems to have the same resistant mechanism as fluoroquinolones. In addition, minimum bactericidal concentrations (MBC) of nemonoxacin to M. pneumoniae were within two dilutions of the MIC values, indicating a bactericidal effect on M. pneumoniae. Nemonoxacin merits further study for treating infections caused by these organisms.
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Affiliation(s)
- Na Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Fudan University, Shanghai, China
| | - Wancheng Liu
- Suzhou Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Suzhou, China
| | - Yunheng Zhou
- Department of Clinical Laboratory, Shanghai Corps Hospital, Chinese People's Armed Police Forces, Shanghai, China
| | - Yang Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Fudan University, Shanghai, China
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