title: Saline-filled breast implant contamination with Curvularia species among women who underwent cosmetic breast augmentation.
abstract: BACKGROUND
  During December 2000-July 2001, black sediment was noted in saline-filled silicone breast implants of women who had undergone revision surgery at facility A. Curvularia fungus was isolated from implant saline.
  
  
  METHODS
  To identify risk factors for contamination with Curvularia species, we performed case-control, retrospective cohort, and laboratory studies and conducted procedural reviews. A case patient was defined as any woman who underwent revision surgery at facility A between January 2000 and June 2001 and had black sediment in her implants.
  
  
  RESULTS
  Five patients met the case definition. Contamination was associated with having had surgery performed in operating room (OR) 2 (4/88 vs. 1/140; P=.07) and a longer duration of surgery (P<.001). A longer duration spent in the OR was an additional risk factor (P=.005). Curvularia fungus was isolated from the sterile supply room, where saline bottles had been stored under a water-damaged ceiling, and from the corridor outside OR 2; it was also found more commonly from facility A personnel than from non-facility A personnel (12/34 vs. 4/60; P<.001). Saline was warmed in a cabinet opposite OR 2, which was maintained at negative pressure differentials, then was poured into bowls open to the OR 2 environment before injection into implants.
  
  
  CONCLUSIONS
  Surgeons should always use closed systems to inflate breast implants. Surgery center infection control measures must include moisture control and balanced ventilation systems.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. marionkainer@state.tn.us.
authors.forename: Marion A
authors.initials: MA
authors.lastname: Kainer
authors.forename: Homa
authors.initials: H
authors.lastname: Keshavarz
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Jensen
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Arduino
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
authors.forename: Arvind A
authors.initials: AA
authors.lastname: Padhye
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: Lennox K
authors.initials: LK
authors.lastname: Archibald
mesh_terms: D001203:Ascomycota / Q000302:isolation & purification*; D018427:Breast Implants / Q000382:microbiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D009181:Mycoses / Q000453:epidemiology*; D012307:Risk Factors; D012965:Sodium Chloride
chemical_list: D012965:Sodium Chloride