Brucella exposure risk events in 10 clinical laboratories, New York City, USA, 2015 to 2017 Journal Article

Authors: Ackelsberg, J.; Liddicoat, A.; Burke, T.; Szymczak, W. A.; Levi, M. H.; Ostrowsky, B.; Hamula, C.; Patel, G.; Kopetz, V.; Saverimuttu, J.; Sordillo, E. M.; D'Souza, D.; Mitchell, E. A.; Lowe, W.; Khare, R.; Tang, Y. W.; Bianchi, A. L.; Egan, C.; Perry, M. J.; Hughes, S.; Rakeman, J. L.; Adams, E.; Kharod, G. A.; Tiller, R.; Saile, E.; Lee, S.; Gonzalez, E.; Hoppe, B.; Leviton, I. M.; Hacker, S.; Ni, K. F.; Orsini, R. L.; Jhaveri, S.; Mazariegos, I.; Dingle, T.; Koll, B.; Stoddard, R. A.; Galloway, R.; Hoffmaster, A.; Fine, A.; Lee, E.; Dentinger, C.; Harrison, E.; Layton, M.
Article Title: Brucella exposure risk events in 10 clinical laboratories, New York City, USA, 2015 to 2017
Abstract: From 2015 to 2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events (Brucella events) in 7 clinical laboratories (CLs). Most patients had traveled to countries where brucellosis is endemic and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as the clinicians did not consider brucellosis until they were notified that bacteremia with Brucella was suspected. In 3 Brucella events, the CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization- time of flight mass spectrometry (MALDI-TOF MS), which has a limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events, which accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including by procedures that could generate infectious aerosols. During 3 Brucella events, the CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each CL, the CL had previously isolated Brucella. Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred. Laboratory assessments were conducted after the Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF MS for identification until BTAs have been ruled out. Copyright © 2020 American Society for Microbiology. All Rights Reserved.
Keywords: clinical article; controlled study; nonhuman; risk factor; risk assessment; public health service; doxycycline; new york; matrix assisted laser desorption ionization time of flight mass spectrometry; rifampicin; serology; clinical laboratory; infection risk; biological product; bacterial growth; occupational exposure; streptococcus; gram negative bacterium; aerosol; brucella melitensis; brucellosis; occupational hazard; human; priority journal; article; biosafety; laboratory infection; laboratory-acquired infection; brucella
Journal Title: Journal of Clinical Microbiology
Volume: 58
Issue: 2
ISSN: 0095-1137
Publisher: American Society for Microbiology  
Date Published: 2020-02-01
Start Page: e01096-19
Language: English
DOI: 10.1128/jcm.01096-19
PUBMED: 31694974
PROVIDER: scopus
PMCID: PMC6989065
Notes: Article -- Export Date: 2 March 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Yi-Wei Tang
    157 Tang