Dominican Republic Surgery Linked to Non-TB Mycobacteria ‏

Laurie Barclay, MD

March 06, 2014

Rapidly growing nontuberculous Mycobacterium (RG-NTM) wound infections have been reported in medical tourists who have undergone cosmetic surgery in the Dominican Republic, according to data published in the March 7 issue of the Morbidity and Mortality Weekly Report.

"In August 2013, the Maryland Department of Health and Mental Hygiene...was notified of two persons with [RG-NTM] surgical-site infections," write David Schnabel, MD, from the Maryland Department of Health and Mental Hygiene, and colleagues. "Both patients had undergone surgical procedures as medical tourists at the same private surgical clinic (clinic A) in the Dominican Republic the previous month. Within 7 days of returning to the United States, both sought care for symptoms that included surgical wound abscesses, clear fluid drainage, pain, and fever."

Antibiotics were not effective, and wound cultures from both patients grew highly antibiotic resistant Mycobacterium abscessus. Alerts issued by the Maryland Department of Health and Mental Hygiene, state and local health departments, the Emerging Infections Network, and the American Society of Plastic Surgeons have identified 19 cases as of February 21, 2014. All the cases are women, aged 18 to 59 years, from 5 states: 11 from New York, 3 from Massachusetts, 2 from Connecticut, 2 from Maryland, and 1 from Pennsylvania.

Of those, 3 were probable cases (16%), defined as a soft tissue infection unresponsive to standard antibiotic treatment in patients who had undergone cosmetic surgery in the Dominican Republic after March 1, 2013, and 16 were confirmed cases (84%), defined as probable cases testing positive for RG-NTM. M abscessus was the responsible pathogen in 13 (81%) of the 16 confirmed cases, Mycobacterium fortuitum in 2 (12%), and 1 species (6%) is still unidentified.

Three Quarters of Cases Needed Prolonged Treatment

The patients underwent cosmetic surgery between March and November 2013, with illness onsets during April to November 2013. Liposuction was the most common surgical procedure (74%), followed by abdominoplasty (58%) and breast implantation (32%).

Although none of the patients died, 14 (74%) were hospitalized in the United States for multiple therapeutic and corrective surgical procedures, as well as prolonged antibiotic therapy. Five received outpatient treatment.

The Centers for Disease Control and Prevention notified Dominican public health authorities of the outbreak investigation and recommended patient follow-up and on-site evaluation of infection control practices. Dominican authorities temporarily closed clinic A.

"This and other outbreaks underscore the risk for infection, including RG-NTM infection, resulting from medical tourism," the report authors conclude. "[The Centers for Disease Control and Prevention] advises all persons planning to receive surgical care outside the United States to verify that the health-care provider and facility they are considering using are licensed and accredited by an internationally recognized accreditation organization before proceeding. These findings indicate that health-care providers consider RG-NTM among patients with a history of cosmetic surgery in the Dominican Republic who also have a surgical-site infection that fails to respond to standard therapy."

The report authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2014;63:201-202. Full text


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.