title: A Cluster of cases of Mycobacterium szulgai keratitis that occurred after laser-assisted in situ keratomileusis.
abstract: Laser-assisted in situ keratomileusis (LASIK) is a recently developed ophthalmic procedure. When 2 patients developed keratitis caused by Mycobacterium szulgai after they underwent LASIK surgery, we conducted a retrospective cohort study of all LASIK procedures performed at Scott & White Clinic (Temple, Texas) during a 4.5-month period. Seven patients had compatible symptoms and signs, 5 of whom had confirmed M. szulgai keratitis. Five cases occurred among 30 procedures performed by doctor A, and there were no cases among 62 procedures performed by doctor B (approximate relative risk, 12.0; 95% confidence interval, 1.6-679.0; P=.0029). Doctor A had chilled syringes of saline solution in ice for intraoperative lavage-the only factor that differentiated the procedures of the 2 surgeons. Cultures of samples from the source ice machine's drain identified M. szulgai; the strain was identical to isolates recovered from all confirmed cases and differed from 4 standard M. szulgai strains, as determined by pulsed-field gel electrophoresis. Intraoperative contamination from ice water apparently led to M. szulgai keratitis in these patients.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Scott & White Memorial Hospital and Clinic, Temple, TX, 76508, USA. gholmes@mailbox.sw.org
authors.forename: Gary P
authors.initials: GP
authors.lastname: Holmes
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Bond
authors.forename: Robert C
authors.initials: RC
authors.lastname: Fader
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Fulcher
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007634:Keratitis / Q000453:epidemiology* / Q000382:microbiology; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009170:Nontuberculous Mycobacteria; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome