RESUMO
Adolfo Lutz Institute in Sao Paolo State performs mycobacterial identification for many healthcare units, and in 2008 identified a possible outbreak involving patients submitted to bronchoscopy at the same hospital. This study aimed to analyse the clonality of isolates. Mycobacterium abscessus subsp. massiliense isolated from 28 patients, water from one bronchoscope and water from four automated endoscope reprocessing machines presented high similarity by pulsed-field gel electrophoresis. This strain was not found in the water supply, and it was hypothesized that an infected patient contaminated the bronchoscope, with further false-positive cultures from subsequent patients.
Assuntos
Broncoscópios/microbiologia , Broncoscopia/efeitos adversos , Surtos de Doenças , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Mycobacterium abscessus/isolamento & purificação , Brasil/epidemiologia , Eletroforese em Gel de Campo Pulsado , Genótipo , Hospitais , Humanos , Epidemiologia Molecular , Tipagem Molecular , Mycobacterium abscessus/classificação , Mycobacterium abscessus/genética , Microbiologia da ÁguaRESUMO
SUMMARY: We investigated an outbreak caused by non-tuberculous mycobacteria (NTM) related to breast implant surgery in the city of Campinas, Brazil, by means of a retrospective cohort and molecular epidemiological study. A total of 492 records of individuals having breast surgery in 12 hospitals were evaluated. Twelve isolates were analysed using four different molecular typing methods. There were 14 confirmed cases, 14 possible cases and one probable case. One probable, nine possible and 12 confirmed cases were included in a cohort study; all occurred in eight of the hospitals and the confirmed cases in five. Univariate analysis showed that patients who had had breast reconstruction surgery in hospitals A and B were more likely to have NTM infections. No risk factor was independently associated with NTM infection in the multivariate model. The isolates obtained from patients at each hospital showed different molecular patterns, excluding isolates from hospital C that repeatedly showed the same genotype for approximately one year. In conclusion, this outbreak was caused by polyclonal strains at different institutions, and in one hospital a unique genotype caused most cases. No specific risk factors were found.
Assuntos
Implante Mamário/efeitos adversos , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Mycobacterium/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , Estudos de Coortes , Infecção Hospitalar/microbiologia , DNA Bacteriano/genética , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Epidemiologia Molecular , Análise Multivariada , Infecções por Mycobacterium/microbiologia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/microbiologiaRESUMO
A cluster of cases of post-augmentation mammaplasty surgical site infections occurred between 2002 and 2004 in Campinas, in the southern region of Brazil. Rapidly growing mycobacteria were isolated from samples from 12 patients. Eleven isolates were identified as Mycobacterium fortuitum and one as Mycobacterium porcinum by PCR-restriction digestion of the hsp65 gene. These 12 isolates, plus six additional M. fortuitum isolates from non-related patients, were typed by pulsed-field gel electrophoresis (PFGE) and three PCR-based techniques: 16S-23S rRNA internal transcribed spacer (ITS) genotyping; randomly amplified polymorphic DNA (RAPD) PCR; and enterobacterial repetitive intergenic consensus (ERIC) PCR. Four novel M. fortuitum allelic variants were identified by restriction analysis of the ITS fragment. One major cluster, comprising six M. fortuitum isolates, and a second cluster of two isolates, were identified by the four methods. RAPD-PCR and ITS genotyping were less discriminative than ERIC-PCR. ERIC-PCR was comparable to PFGE as a valuable complementary tool for investigation of this type of outbreak.