Infection Due to Organisms of the Mycobacterium fortuitum Complex after Augmentation Mammaplasty: Clinical and Epidemiologic Features

Abstract

Periprosthetic infections due to Mycobacterium fortuitum and Mycobacterium chelonei occurred in 17 women over a 3.5-year period after implantation of prostheses for breast augmentation. The median incubation period for 16 of the women was 28 days (range, one week to over two years) after surgery; etiologic diagnosis was usually delayed for weeks to months. Odorless and serosanguineous or purulent material was found when the implants were removed, and acid-fast bacilli were often present when smears were examined. Wound infections were chronic and refractory to therapy with various antimicrobial agents. Persistent or recurrent mycobacterial infections complicated attempts to implant new prostheses. Whereas M. fortuitum isolates were susceptible to amikacin, multiple strains of M. fortuitum were distinguished by conventional antituberculous and broth microdilution susceptibility tests. Several clusters of infections were temporally and geographically related; however, sporadic cases were also reported, and no evidence of a contaminated common product or other single source of infection was found.

Iatrogenic outbreak of M. chelonae skin abscesses

“…In most of the outbreaks caused by rapidly growing mycobacteria, the source and the nature of the responsible microorganism have not been established [1,15,20,21,24,25,41,42] but, in general, water, aqueous solutions and the environment have been suggested as the source of contamination. Wallace discusses the importance of geographic location, seasonal factors, adequacy of air filtration and the presence of nonsterile water in the operating room [38].…”

“…Other studies have established periods between 3 days and 2 years [15,17,18,20,24,25,41,42], but none of them followed Sartwell's methodology. Using data from one of the outbreaks [17], we could calculate a median incubation period of 34 days with a dispersion factor of 19, data very similar to ours.…”

Epidemiology of Infection by Nontuberculous Mycobacteria

“…Surgical wound infections associated with cardiac bypass surgery (525) or augmentation mammaplasty (82,527) are often clustered and occur more frequently in Texas and the southern coastal region of the United States.…”

Infecção por micobactéria após videoartroscopia: o glutaraldeído pode ser o culpado? Estudo experimental in vitro

“…As infecções associadas a ele incluem doença pulmonar, endocardite, otite média, mastoidite e ceratite. Outros tipos de infecções causadas por Mycobacterium (abcessus/ fortuitum/chelonae) foram identificados em procedimentos cirúrgicos estéticos como liposucção e lipoescultura, administração parenteral de vitaminas, extrato de córtex adrenal, lidocaína, silicone, tratamento de acupuntura, colocação de piercing mamilar e banhos em piscinas, uma vez que essa bactéria já foi encontrada em água tratada nas caixas d'água de hospitais (7)(8)(9)(10)(11)(12)(13)(14) . Sua presença nesses locais implica desdobramentos preocupantes, uma vez que foi fonte de problemas em vários setores de serviços de saúde, sendo associadas com fluidos de hemodiáli-se e soluções desinfetantes (6)(7)13) .…”