Are infectious respiratory precautions required for patients with Mycobacterium abscessus infection?

Respiratory Precautions for Patients with Mycobacterium abscessus Infection

Standard precautions are generally sufficient for patients with Mycobacterium abscessus infection, as there is no evidence supporting the need for airborne isolation precautions that are typically used for Mycobacterium tuberculosis. Unlike tuberculosis, M. abscessus does not require the specialized airborne precautions with negative pressure rooms.

Understanding M. abscessus Transmission

M. abscessus is a rapidly growing nontuberculous mycobacterium (NTM) found in soil and water throughout the world 1. While it can cause serious infections, particularly in immunocompromised hosts, its transmission dynamics differ significantly from M. tuberculosis:

• M. abscessus primarily causes localized skin and soft tissue infections in immunocompetent patients
• Respiratory infections are common but not typically transmitted person-to-person through airborne routes
• Disseminated disease is uncommon and usually occurs in immunocompromised hosts 1

Appropriate Infection Control Measures

Standard Precautions

• Hand hygiene
• Use of personal protective equipment (gloves, gowns) when contact with body fluids is anticipated
• Safe injection practices
• Respiratory hygiene/cough etiquette for patients with respiratory symptoms

Special Considerations

While the CDC guidelines for preventing tuberculosis transmission 2 provide extensive recommendations for M. tuberculosis, these specific airborne precautions are not routinely indicated for M. abscessus. However:

• For patients undergoing cough-inducing procedures who have M. abscessus pulmonary infection, standard precautions with additional droplet precautions may be prudent
• Surgical masks (worn by the patient) can help reduce droplet transmission during procedures or transport 2

Specific Scenarios Requiring Enhanced Precautions

In certain high-risk settings or procedures, additional precautions may be warranted:

1. Cystic Fibrosis (CF) Settings: Evidence suggests possible patient-to-patient transmission of M. abscessus in CF populations. A multifaceted infection control strategy including patient isolation has been effective in halting transmission in CF centers 3.

2. Cough-Inducing Procedures: For bronchoscopy or sputum induction in patients with known M. abscessus infection, performing these procedures in rooms with appropriate ventilation and using respiratory protection for healthcare workers is reasonable 2.

3. Immunocompromised Settings: In units with severely immunocompromised patients, additional precautions may be considered given the higher risk of severe disease in these populations 4.

Risk Assessment Approach

Transmission-based precautions should be implemented based on infection control risk assessment 5. For M. abscessus, this assessment should consider:

• Patient factors (immunosuppression, presence of cystic fibrosis)
• Type of infection (pulmonary vs. extrapulmonary)
• Procedure-related risks (cough-inducing procedures)
• Institutional factors (presence of high-risk patients in the vicinity)

Common Pitfalls to Avoid

1. Unnecessary isolation: Placing M. abscessus patients in airborne isolation rooms designed for tuberculosis is generally unnecessary and wastes resources

2. Confusing with tuberculosis: M. abscessus and M. tuberculosis have different transmission dynamics and require different precautions

3. Overlooking environmental sources: Environmental decontamination may be more important than patient isolation for preventing M. abscessus transmission, as it is often acquired from environmental sources

4. Neglecting standard precautions: While specialized respiratory precautions are not typically needed, strict adherence to standard precautions remains essential

By following these guidelines, healthcare facilities can appropriately manage infection control for patients with M. abscessus while avoiding unnecessary restrictions and resource utilization.