Mycobacterium abscessus point source outbreak in the local potable water supply affecting people with cystic fibrosis

Abstract

Introduction/Aim: Mycobacterium abscessus group (MABS) are emerging respiratory pathogens in people with cystic fibrosis (CF). The acquisition of MABS infection is poorly understood. MABS has been detected in drinking water distribution systems (Thomson R, et al. BMC Infect Dis. 2013;13:241; Morimoto K, et al. ERJ Open Res. 2018;4(3). pii: 00150-2017). We aimed to determine the role of potable water in the acquisition and transmission of MABS respiratory infection. Methods: 156 MABS respiratory isolates from 68 participants with CF stored at Queensland Mycobacterium Reference Laboratory from 2000-2017 were compared with 52 MABS isolates recovered from potable water sampling. The whole genome sequences of the clinical and environmental isolates were compared to determine their relatedness (Bryant JM, et al. Science. 2016;354:751-7). Results: Certain clinical and environmental isolates were closely related and a possible point source outbreak (PSO) identified in the local water supply. The clinical and environmental isolates in the PSO were separated by a maximum of 32 single-nucleotide polymorphisms and included isolates recovered from hospital water, home water, distribution pipe water, and respiratory isolates from two unrelated people with CF. The direction of infection, patient-to-environment or environment-to-patient, could not be inferred. Conclusion: Potable water is a likely source of MABS respiratory infection in people with CF; however, wider environmental sampling and sequencing of broader clinical isolates (including non-CF respiratory and extra-pulmonary MABS isolates) is required to determine the role of the environment (particularly direction of transmission) in the global spread of MABS respiratory infection. (Table Presented).L6293884902019-09-26 <br />