Potable water as a possible source of mycobacterium abscessus complex infection in people with cystic fibrosis

Abstract

Introduction: Mycobacterium abscessus complex (MABSC) are emerging respiratory pathogens in people with cystic fibrosis (CF; Bar-On O, et al. J Cyst Fibros. 2015;14:53-62) and their acquisition and transmission pathways are poorly understood. Up to 25% of MABSC strains in people with CF are unique genotypes and may be acquired environmentally (Bryant JM, et al. Science. 2016;354:751-7). Potable water is a known environmental source of MABSC (Thomson R, et al. J Clin Microbiol. 2013;51:3006-11). This study investigates the presence of MABSC in potable water of hospitals and homes in Queensland, Australia. Methods: Hospital: Water was sampled from showers and sink taps (n=12) of The Prince Charles Hospital (TPCH) over 5 sampling time points (2014-17) and the former Royal Children's Hospital (RCH) at a single time point (2015). Home: A minimum of 3 water points were sampled from participants' homes; shower, bathroom sink and kitchen sink taps. The participants were divided into 4 groups: 1) CF and active MABSC respiratory infection (<2 years since positive culture; n=10), 2) CF and past MABSC respiratory infection (>2 years since positive culture; n=7) or 3) CF and never infected with NTM (n=8), and 4) homes of people with no lung disease (n=8). All water samples were incubated for 8 weeks. The genomes of presumptive NTM isolates were sequenced. Results:Hospital: Detection of MABSC in water samples collected at TPCH was variable longitudinally with a range of 0-25% water points positive per time point. At the RCH, MABSC was detected in water samples collected from 2/12 (17%) water points. Home: MABSC was detected in 6/136 (4%) home water points. Genomic analysis of MABSC isolates from hospital and home water showed them to be closely related to respiratory MABSC isolates from people with CF. Conclusions: The genetic relatedness of the water and respiratory MABSC isolates demonstrates that potable water may be a potential source of MABSC respiratory infection in some people with CF (Table Presented) .L6240490872018-10-02 <br />