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Risk Factors for Mycobacterium abscessus subsp. bolletii Infection After Laparoscopic Surgery During an Outbreak in Brazil

Published online by Cambridge University Press:  05 January 2015

Gabriela Baruque Villar ,
Felipe Teixeira de Mello Freitas ,
Jesus Pais Ramos ,
Carlos Eduardo Dias Campos ,
Paulo Cesar de Souza Caldas ,
Fernanda Santos Bordalo ,
Tatyana Costa Amorim Ramos ,
Vívian do Nascimento Pereira ,
Marcelo Cordeiro-Santos  and
Joao Hugo Abdalla Santos
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Gabriela Baruque Villar*
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
Felipe Teixeira de Mello Freitas
Affiliation:
Núcleo de Medicina Tropical, Universidade de Brasília, Brasilia, Distrito Federal, Brazil
Jesus Pais Ramos
Affiliation:
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
Carlos Eduardo Dias Campos
Affiliation:
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
Paulo Cesar de Souza Caldas
Affiliation:
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
Fernanda Santos Bordalo
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
Tatyana Costa Amorim Ramos
Affiliation:
Comissão Estadual de Controle de Infecção hospitalar, Fundação de Vigilância em Saúde, Manaus, Amazonas, Brazil
Vívian do Nascimento Pereira
Affiliation:
Comissão Estadual de Controle de Infecção hospitalar, Fundação de Vigilância em Saúde, Manaus, Amazonas, Brazil
Marcelo Cordeiro-Santos
Affiliation:
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
Joao Hugo Abdalla Santos
Affiliation:
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
Glauco Coelho Motta
Affiliation:
Laboratório Central de Saúde Pública do Amazonas, Fundação de Vigilância em Saúde, Manaus, Amazonas, Brazil
Suzie Marie Gomes
Affiliation:
Brazillian Sanitary Agency (Agência Nacional de Vigilância Sanitária), Brasilia, Distrito Federal, Brazil
Verena Maria Mendes de Souza
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
Wildo Navegantes de Araujo
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil Universidade de Brasília - Campus Ceilândia, Brasilia, Distrito Federal, Brazil
*
Address correspondence to Gabriela B. Villar, MD, MSc, Esplanada dos Ministérios Bloco G, Ministério da Saúde, Ed. Sede, 1st floor, room 137, Brasília, Distrito Federal, Brazil (villargb@gmail.com).
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Abstract

OBJECTIVE

To identify risk factors related to Mycobacterium abscessus subsp. bolletii infection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases.

DESIGN

A retrospective cohort study.

SETTING

A private hospital in Manaus, Brazil.

PATIENTS

A cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team.

METHODS

We collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables with P≤0.2 in the bivariate analysis in a logistic regression model. Additionally, we reviewed the procedures for reprocessing the laparoscopic surgery equipment, and the strains obtained with culture were identified by molecular methods.

RESULTS

We recorded 60 (27%) cases of infection. After multivariate analysis, the duration of surgery beyond 1 hour (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2–4.5), not to have been the first operated patient on a given day (OR, 2.7; 95% CI, 1.4–5.2), and the use of permanent trocar (OR, 2.2; 95% CI, 1.1–4.2) were associated with infection. We observed that the surgical team attempted to sterilize the equipment in glutaraldehyde solution when sanitary authorities had already prohibited it. Eleven strains presented 100% DNA identity with a single strain, known as BRA100 clone.

CONCLUSIONS

Because contaminated material can act as vehicle for infection, ensuring adequate sterilization processing of video-assisted surgery equipment was crucial to stopping this single clonal outbreak of nonturbeculous mycobacteria in Brazil.

Infect Control Hosp Epidemiol 2015;36(1): 81–86

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 81 - 86
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1.Sampaio, JL, Chimara, E, Ferrazoli, L, et al. Application of four molecular typing methods for analysis of Mycobacterium fortuitum group strains causing post-mammaplasty infections. Clin Microbiol Infect 2006;12:142–149.Google Scholar
2.Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Secretaria de Vigilância em Saúde. Nota técnica conjunta no. 01/2009 - SVS/MS e ANVISA. Infecções por micobactérias de crescimento rápido: fluxo de notificações, diagnósticos clínico, microbiológico e tratamento. Published 2009. Accessed December 01, 2011.Google Scholar
3.Sampaio, JL, Viana-Niero, C, de Freitas, D, Höfling-Lima, AL, Leão, SC. Enterobacterial repetitive intergenic consensus PCR is a useful tool for typing Mycobacterium chelonae and Mycobacterium abscessus isolates. Diagn Microbiol Infect Dis 2006;55:107–118.Google Scholar
4.Viana-Niero, C, Lima, KV, Lopes, ML, et al. Molecular characterization of Mycobacterium massiliense and Mycobacterium bolletii in isolates collected from outbreaks of infections after laparoscopic surgeries and cosmetic procedures. J Clin Microbiol 2008;46:850–855.Google Scholar
5.Zelazny, AM, Root, JM, Shea, YR, et al. Cohort study of molecular identification and typing of Mycobacterium abscessus, Mycobacterium massiliense, and Mycobacterium bolletii. J Clin Microbiol 2009;47:1985–1995.Google Scholar
6.Leao, SC, Tortoli, E, Euzéby, JP, Garcia, MJ. Proposal that Mycobacterium massiliense and Mycobacterium bolletii be united and reclassified as Mycobacterium abscessus subsp. bolletii comb. nov., designation of Mycobacterium abscessus subsp. abscessus subsp. nov. and emended description of Mycobacterium abscessus. Int J Syst Evol Microbiol 2011;61:2311–2313.Google Scholar
7.Monego, F, Duarte, RS, Nakatani, SM, et al. Molecular identification and typing of Mycobacterium massiliense isolated from postsurgical infections in Brazil. Braz J Infect Dis 2011;15:436–441.Google ScholarPubMed
8.Cardoso, AM, Sousa, EM, Viana-Niero, C, et al. Emergence of nosocomial Mycobacterium massiliense infection in Goias, Brazil. Microbes Infect 2008;10:1552–1557.Google Scholar
9.Duarte, RS, Lourenço, MCS, Fonseca, LS, et al. An epidemic of post-surgical infections caused by Mycobacterium massiliense. J Clin Microbiol 2009;47:2149–2155.Google Scholar
10.Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Unidade de Investigação e Prevenção das Infecções e dos Eventos Adversos. Gerência Geral de Tecnologia em Serviços de Saúde. Relatório descrito de investigação de casos de infecções por micobactérias não tuberculosas de crescimento rápido (MCR) no Brasil no período de 1998 a 2009. Published 2010. Accessed December 01, 2011.Google Scholar
11.Ministério da Saúde(MS). Agência Nacional de Vigilância Sanitária (ANVISA). Resolução RDC 08 de 27/02/09. http://www.anvisa.gov.br/hotsite/segurancadopaciente/documentos/rdcs/RDC%20N%C2%BA%2008-2009.pdf. Published 2009. Accessed September 6, 2012.Google Scholar
12.Instituto Brasileiro de Geografia e Estatística. Estimativas de população para 1o de julho de 2010, segundo os municípios. http://cidades.ibge.gov.br/xtras/perfil.php?lang=&codmun=130260&search=amazonas|manaus. Published 2011. Accessed June 12, 2011.Google Scholar
13.Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Ficha de Notificação de caso de micobacteriose não tuberculosa (MCR) após procedimentos médicos invasivos.http://www.anvisa.gov.br/divulga/informes/2007/070307_form.pdf. Published 2007. Accessed December 01, 2011.Google Scholar
14.Telenti, A, Marchesi, F, Balz, M, Bally, F, Böttger, EC, Bodmer, T. Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol 1993;31:175–178.Google Scholar
15.Adékambi, T, Colson, P, Drancourt, M. rpoB-based identification of nonpigmented and late-pigmenting rapidly growing mycobacteria. J Clin Microbiol 2003;41:5699–5708.Google Scholar
16.Altschul, SF, Madden, TL, Schäffer, AA, et al. Gapped BLAST and PSI-BLAST: a new generation of protein database search programs. Nucleic Acids Res 1997;25:3389–3402.Google Scholar
17.Oliveira, JCC, Blank, N, Damerau, EF. Fatores de risco para infecção de sítio cirúrgico em cirurgia colorretal eletiva. Rev bras Coloproct 2001;21:75–83.Google Scholar
18.Astagneau, P, Desplaces, N, Vincent, V, et al. Mycobacterium xenopi spinal infections after discovertebral surgery: investigation and screening of a large outbreak. Lancet 2001;358:747–751.Google Scholar