An Outbreak of Mycobacterium chelonae Infection Following Liposuction

Among 82 patients who underwent liposuction performed by a single practitioner in a 6-month period, 34 (41%) developed cutaneous abscesses. An organism identified as Mycobacterium chelonae by polymerase chain reaction restriction-enzyme analysis was recovered from cultures of samples from 12 of those patients. DNA large restriction-fragment pattern analysis by pulsed-field gel electrophoresis demonstrated that a strain of M. chelonae recovered from biofilm in the piped-water system in one of the physician’s offices differed by only 2 restriction fragments from the 12 patient isolates, which differed from each other by 0 or 1 restriction fragment. A detailed retrospective cohort study that included interviews with former employees and statistical analysis of risk factors indicated that inadequate sterilization and rinsing of surgical equipment with tap water were likely sources of mycobacterial contamination. This is the first reported outbreak of nosocomial infection due to M. chelonae in which a source has been identified and the first to occur in association with liposuction in patients in the United States. Infections caused by rapidly growing mycobacteria (RGM) are relatively uncommon [1–13]. Cutaneous infection is the most common presentation [2–4] and, in most cases, follows penetrating trauma [3, 4]. Out-breaks of nosocomial surgical-site RGM infection [4–8], most often due to Mycobacterium fortuitum or Mycobacterium abscessus, have been associated with car-diothoracic surgery, augmentation mammaplasty, and facial plastic surgery [6–9]. Liposuction is a common cosmetic procedure. Ap-proximately 150,000 liposuction procedures were per-formed in the United States in 1997 by board-certified plastic surgeons who were members of the America