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Investigation of a Mycobacterium fortuitum prosthetic joint infection outbreak at two ambulatory surgery centers in Tennessee

Published online by Cambridge University Press:  14 October 2025

Simone Godwin Open the ORCID record for Simone Godwin [Opens in a new window] ,
Ashley Gambrell Open the ORCID record for Ashley Gambrell [Opens in a new window] ,
Becky A. Meyer Open the ORCID record for Becky A. Meyer [Opens in a new window] ,
Christopher Wilson ,
Melphine M. Harriott Open the ORCID record for Melphine M. Harriott [Opens in a new window] ,
Morgan Duckett ,
Kendall Ferrell ,
Morgan McMahan ,
Tracey Rhodes  and
Kelley M. Tobey
...Show all authors
Simone Godwin*
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Ashley Gambrell
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Becky A. Meyer
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Christopher Wilson
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Melphine M. Harriott
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Morgan Duckett
Affiliation:
Knox County Health Department, Knoxville, TN, USA
Kendall Ferrell
Affiliation:
Knox County Health Department, Knoxville, TN, USA
Morgan McMahan
Affiliation:
Knox County Health Department, Knoxville, TN, USA
Tracey Rhodes
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Kelley M. Tobey
Affiliation:
Healthcare-Associated Infections and Antimicrobial Resistance Program of the Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
Megan Edwards
Affiliation:
Knox County Health Department, Knoxville, TN, USA
Corinne Tandy
Affiliation:
Knox County Health Department, Knoxville, TN, USA
*
Corresponding author: Simone Godwin; Email: Simone.Godwin@tn.gov
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Abstract

Objective:

This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge.

Methods:

Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire.

Results:

IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16–985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing.

Conclusion:

The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 12 , December 2025 , pp. 1215 - 1221
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Falkinham, J. Ecology of nontuberculous mycobacteria. Microorganisms 2021;9:2262. https://doi.org/10.3390/microorganisms9112262. https://www.mdpi.com/2076-2607/9/11/2262.CrossRefGoogle Scholar
Falkinham, JO, 3rd. Nontuberculous mycobacteria in the environment. Tuberculosis (Edinb) 2022;137:102267 CrossRefGoogle ScholarPubMed
Hayward, C, Brown, MH, Whiley, H. Hospital water as the source of healthcare-associated infection and antimicrobial-resistant organisms. Curr Opin Infect Dis 2022;35:339–345 CrossRefGoogle Scholar
Gardini, G, Gregori, N, Matteelli, A, Castelli, F. Mycobacterial skin infection. Curr Opin Infect Dis 2022;35:79–87 CrossRefGoogle ScholarPubMed
Szturmowicz, M, Oniszh, K, Wyrostkiewicz, D, Radwan-Rohrenschef, P, Filipczak, D, Zabost, A. Non-tuberculous mycobacteria in respiratory specimens of patients with obstructive lung diseases-colonization or disease? Antibiotics (Basel) 2020;9. https://www.mdpi.com/2079-6382/9/7/424. https://www.mdpi.com/journal/antibiotics/imprint.CrossRefGoogle Scholar
Bryant, JM, Grogono, DM, Rodriguez-Rincon, D, et al. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium. Science 2016;354:751–757 CrossRefGoogle ScholarPubMed
Kaul, CM, Chan, J, Phillips, MS. Mitigation of nontuberculous mycobacteria in hospital water: challenges for infection prevention. Curr Opin Infect Dis 2022;35:330–338 CrossRefGoogle ScholarPubMed
Kunz, JM, Lawinger, H, Miko, S, et al. Surveillance of waterborne disease outbreaks associated with drinking water – united states, 2015–2020. MMWR Surveill Summ 2024;73:1–23 CrossRefGoogle ScholarPubMed
Sommerstein, R, Schreiber, PW, Diekema, DJ, et al. Mycobacterium chimaera outbreak associated with heater-cooler devices: piecing the puzzle together. Infect Control Hosp Epidemiol 2017;38:103–108 CrossRefGoogle ScholarPubMed
Ma, X, Li, XY, Liu, JW. Demographic and clinical features of nontuberculous mycobacteria infection resulting from cosmetic procedures: a systematic review. Int J Infect Dis 2024;149:107259 CrossRefGoogle ScholarPubMed
Scheflan, M, Wixtrom, RN. Over troubled water: an outbreak of infection due to a new species of mycobacterium following implant-based breast surgery. Plast Reconstr Surg 2016;137:97–105 CrossRefGoogle Scholar
Phillips, MS, von Reyn, CF. Nosocomial infections due to nontuberculous mycobacteria. Clin Infect Dis 2001;33:1363–1374 CrossRefGoogle ScholarPubMed
Buser, GL, Laidler, MR, Cassidy, PM, Moulton-Meissner, H, Beldavs, ZG, Cieslak, PR. Outbreak of nontuberculous mycobacteria joint prosthesis infections, Oregon, USA, 2010–2016. Emerg Infect Dis 2019;25:849–855 CrossRefGoogle ScholarPubMed
Eid, AJ, Berbari, EF, Sia, IG, Wengenack, NL, Osmon, DR, Razonable, RR. Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature. Clin Infect Dis 2007;45:687–694 CrossRefGoogle ScholarPubMed
Groenewold, MR, Flinchum, A, Pillai, A, et al. Investigation of a cluster of rapidly growing mycobacteria infections associated with joint replacement surgery in a Kentucky hospital, 2013–2014 with 8-year follow-up. Am J Infect Control 2023;51:454–460 CrossRefGoogle Scholar
Maimaiti, Z, Li, Z, Xu, C, et al. Non-tuberculosis mycobacterium periprosthetic joint infections following total hip and knee arthroplasty: case series and review of the literature. Orthop Surg 2023;15:1488–1497 CrossRefGoogle ScholarPubMed
Peng, SH, Lee, SH, Chen, CC, et al. Nontuberculous mycobacteria peri-prosthetic joint infection: an outcome analysis for two stage revision arthroplasty. J Orthop Surg (Hong Kong) 2022;30:10225536221140610 CrossRefGoogle ScholarPubMed
Wang, KY, Puvanesarajah, V, Marrache, M, Ficke, JR, Levy, JF, Jain, A. Ambulatory surgery centers versus hospital outpatient departments for orthopaedic surgeries. J Am Acad Orthop Surg 2022;30:207–214 CrossRefGoogle ScholarPubMed
Rhee, C, Huang, SS, Berrios-Torres, SI, et al. Surgical site infection surveillance following ambulatory surgery. Infect Control Hosp Epidemiol 2015;36:225–228 CrossRefGoogle ScholarPubMed
Villa, CH, Illoh, O, Kracalik, I, Basavaraju, SV, Eder, AF. Posttransfusion sepsis attributable to bacterial contamination in platelet collection set manufacturing, United States. Transfusion 2023;63:2351–2357 CrossRefGoogle ScholarPubMed
Petkau, A, Mabon, P, Sieffert, C, et al. SNVPhyl: a single nucleotide variant phylogenomics pipeline for microbial genomic epidemiology. Microb Genom 2017;3:e000116 CrossRefGoogle Scholar
Halpin, AL, McDonald, LC, Elkins, CA. Framing bacterial genomics for public health (Care). J Clin Microbiol 2021;59:e0013521 CrossRefGoogle Scholar
Rose, LJ, Houston, H, Martinez-Smith, M, et al. Factors influencing environmental sampling recovery of healthcare pathogens from non-porous surfaces with cellulose sponges. PLoS One 2022;17:e0261588 CrossRefGoogle Scholar
Rahav, G, Pitlik, S, Amitai, Z, et al. An outbreak of Mycobacterium jacuzzii infection following insertion of breast implants. Clin Infect Dis 2006;43:823–830 CrossRefGoogle ScholarPubMed
Kang, L, Dewar, D, Lobo, A. Examination of surgical helmet and surgical hood application methods in reducing contamination in arthroplasty surgery. Arthroplast Today 2021;7:157–160 CrossRefGoogle ScholarPubMed
Lindsley, WG, Blachere, FM, Derk, RC, Mnatsakanova, A, Noti, JD. Efficacy of powered air-purifying respirators (PAPRs) for source control of simulated respiratory aerosols. Am J Infect Control 2024;52:1397–1402.CrossRefGoogle ScholarPubMed