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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.
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