Abstract
Rapidly growing mycobacteria (RGM) can cause a broad spectrum of both community and healthcare-associated infections in humans. The aim of this study was to report the clinical management and outcomes of successive patients following cesarean delivery with healthcare-associated surgical site infections (SSIs) caused by RGM. Patients who were admitted to Chung Shan Medical University Hospital, Taichung, Taiwan, between September 2006 and July 2008, and who developed SSIs following cesarean delivery at an obstetrics hospital and were then referred to our hospital, were enrolled. Demographic characteristics of the patients and clinical isolates were obtained retrospectively and an environmental investigation was performed. PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of the hsp65gene and pulsed-field gel electrophoresis (PFGE) of large genomic DNA restriction fragments were applied to differentiate Mycobacterium species. Seventeen patients were diagnosed with RGM infections by microbiology and/or histopathology. Mycobacterial isolates by PCR-RFLP analysis from 15 patients revealed Mycobacterium abscessus (M. abscessus) and M. lentiflavum. Most of the patients received surgical debridement and combination antimicrobial therapy and were eventually cured. Our study demonstrates the potential that RGM infections have in causing healthcare-associated SSIs. Surgery plus prolonged combination antimicrobial therapy seemed to be an effective option for the management of M. abscessus infections.
Highlights
Growing mycobacteria (RGM) can cause a broad spectrum of both community and healthcare-associated infections in humans
Rapidly growing mycobacteria (RGM) infections have emerged as a significant cause of healthcareassociated infections (HAIs) in recent years [8,14,15,34,35,36,37,38,39,40]
Healthcare-associated surgical site infections (SSIs) caused by M. abscessus involving inguinal herniotomy, cosmetic surgery, cataract surgery, and outbreaks of injectionrelated M. abscessus infections following contaminated materials have been reported previously [10,35,36]
Summary
Growing mycobacteria (RGM) can cause a broad spectrum of both community and healthcare-associated infections in humans. The aim of this study was to report the clinical management and outcomes of successive patients following cesarean delivery with healthcare-associated surgical site infections (SSIs) caused by RGM. Nontuberculous mycobacteria (NTM) exist widely in the environment, occurring in natural and tap water systems, plant materials, and soil These organisms can cause pulmonary disease, skin and soft tissue infections (SSTI), lymphadenitis, and disseminated disease in humans [1,2,3,4,5]. Mycobacterium abscessus (M. abscessus), an RGM species, has been shown to be resistant in vitro to several antiseptic agents such as chlorine and glutaraldehyde [7] These organisms are frequently detected in hospital water systems, endoscopy equipment, andchronic ventilator settings, and most commonly cause HAIs, outbreaks, pseudo-outbreaks, and surgical site infections (SSIs) [8,9]. Healthcareassociated surgical infections caused by M.abscessus have been documented following liposuction [10], rhytidectomy [11], acupuncture [12], mesotherapy
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