Brief Report: Nontuberculous Mycobacterial Infections After Cosmetic Surgery --- Santo Domingo, Dominican Republic, 2003--2004

Rapidly growing mycobacteria have been associated with postoperative infections in patients undergoing cosmetic surgery procedures (1,2). In April 2004, CDC received reports of infections caused by rapidly growing mycobacteria in patients who had undergone cosmetic surgery procedures in Santo Domingo, Dominican Republic (DR). CDC, along with state and local health departments, is investigating additional cases identified by passive surveillance (i.e., solicitation of reports from clinicians by using electronic networks) and, in some areas, active surveillance (i.e., review of laboratory reports).

A total of 12 cases, all laboratory confirmed, have been reported from residents of New York (five), Massachusetts (two), North Carolina (two), Rhode Island (two), and Puerto Rico (one). Definitive testing at CDC has determined that all the cases resulted from infection with Mycobacterium abscessus. The patients underwent procedures in multiple surgical centers in Santo Domingo during May 2003--February 2004. Eleven of the 12 patients were interviewed. All were women; median age was 32 years (range: 19--59 years). Surgical procedures consisted of one or more of the following: abdominoplasty (i.e., "tummy tuck") (10 patients), liposuction (five), breast lift (four), breast reduction (four), and breast implant (one). Symptoms of infection began a median of 5 weeks after surgery (range: 1--20 weeks) and included subcutaneous or deep-tissue abscesses requiring incision, drainage, and antibiotic therapy in all patients; nine patients were hospitalized. Molecular typing using pulsed-field gel electrophoresis and randomly amplified polymorphic DNA polymerase chain reaction confirmed that M. abscessus isolates from seven of 12 specimens were indistinguishable. Organisms with this common genetic pattern were recovered from patients who had surgery performed during October--December 2003 in the same surgical center in Santo Domingo.

The source and magnitude of this cluster are not known; public health authorities in DR have initiated an onsite investigation. Infection with rapidly growing, nontuberculous mycobacteria should be considered in patients who have undergone cosmetic surgery procedures in DR and who subsequently have surgical-site infections that fail to respond to standard therapy. Cases of mycobacterial subcutaneous infections after cosmetic surgery procedures undergone since May 2003 in DR should be reported through state and local health departments to CDC, telephone 800-893-0485.

Reported by: State and local health departments. Div of Healthcare Quality Promotion, National Center for Infectious Diseases; Div of TB Elimination, National Center for HIV, STDs, and TB Prevention; C Estivariz, MD, EIS Officer, CDC.

References

1. CDC. Mycobacterium chelonae infections associated with face lifts---New Jersey, 2002--2003. MMWR 2004;53:192--4.
2. CDC. Rapidly growing mycobacterial infection following liposuction and liposculpture---Caracas, Venezuela, 1996--1998. MMWR 1998; 47:1065--7.

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