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Epidemiology of Mycobacterium abscessus in England: an observational study

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Abstract

Background

Mycobacterium abscessus has emerged as a major scientific concern following reviews that it’s readily transmissible in health-care settings between sufferers with cystic fibrosis. We linked routinely collected whole-genome sequencing and health-care utilization knowledge with the intention of investigating the extent to which such transmission explains acquisition in sufferers with and with out cystic fibrosis in England.

Strategies

On this retrospective observational study, we analysed consecutive M abscessus whole-genome sequencing knowledge from England (starting of February, 2015, to Nov 14, 2019) to determine genomically comparable isolates. Linkage to a nationwide health-care utilization database was used to analyze potential contacts between sufferers. Multivariable regression evaluation was performed to analyze elements related to acquisition of a genomically clustered pressure (genomic distance <25 single nucleotide polymorphisms [SNPs]).

Findings

2297 isolates from 906 sufferers underwent whole-genome sequencing as half of the routine Public Well being England diagnostic service. Of 14 genomic clusters containing isolates from ten or extra sufferers, all however one contained sufferers with cystic fibrosis and sufferers with out cystic fibrosis. Sufferers with cystic fibrosis have been equally prone to have clustered isolates (258 [60%] of 431 sufferers) as these with out cystic fibrosis (322 [63%] of 513 sufferers; p=0·38). Excessive-density phylogenetic clusters have been randomly distributed over a large geographical space. Most isolates with a closest genetic neighbour in keeping with potential transmission had no identifiable related epidemiological contacts. Having a clustered isolate was independently related to rising age (adjusted odds ratio 1·14 per 10 years, 95% CI 1·04–1·26), however not time spent as an hospital inpatient or outpatient. We recognized two sibling pairs with cystic fibrosis with genetically extremely divergent isolates and one pair with carefully associated isolates, and 25 uninfected presumed family contacts with cystic fibrosis.

Interpretation

Beforehand recognized broadly disseminated dominant clones of M abscessus aren’t restricted to sufferers with cystic fibrosis and happen in different persistent respiratory illnesses. Though our evaluation confirmed a small quantity of circumstances the place person-to-person transmission couldn’t be excluded, it didn’t help this being a serious mechanism for M abscessus dissemination at a nationwide degree in England. Total, these knowledge ought to reassure sufferers and clinicians that the danger of acquisition from different sufferers in health-care settings is comparatively low and inspire future analysis efforts to deal with figuring out routes of acquisition exterior of the cystic fibrosis health-care-associated area of interest.

Funding

The Nationwide Institute for Well being Analysis, Well being Knowledge Analysis UK, The Wellcome Belief, The Medical Analysis Council, and Public Well being England.

Introduction

Mycobacterium abscessus pulmonary illness might be devastating in sufferers with cystic fibrosis. This pathogen is very antibiotic-resistant and remedy is difficult. M abscessus pulmonary illness (attributable to one of three subspecies: massiliense, abscessus, and bolletii) might be progressive and incurable and is a relative contraindication to lung transplantation. In frequent with different non-tuberculous mycobacteria, acquisition of M abscessus was till lately thought-about solely to happen from the atmosphere, particularly from contaminated water sources.

  • Feazel LM
  • Baumgartner LK
  • Peterson KL
  • Frank DN
  • Harris JK
  • Tempo NR
Opportunistic pathogens enriched in showerhead biofilms.