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Between July 1987 and January 1988, five patients at a California hemodialysis clinic developed systemic Mycobacterium chelonae abscessus infections, with four having arteriovenous graft infections and two fatalities. The outbreak was linked to the use of high-flux dialyzers that were inadequately disinfected with 2.5% Renalin, which failed to eliminate the bacteria. Recommendations include early diagnosis and complete graft removal along with improved disinfection protocols to prevent future infections.

Author
Shin Barbie
Language
EN