title: Epidemic of postsurgical infections caused by Mycobacterium massiliense.
abstract: An epidemic of infections after video-assisted surgery (1,051 possible cases) caused by rapidly growing mycobacteria (RGM) and involving 63 hospitals in the state of Rio de Janeiro, Brazil, occurred between August 2006 and July 2007. One hundred ninety-seven cases were confirmed by positive acid-fast staining and/or culture techniques. Thirty-eight hospitals had cases confirmed by mycobacterial culture, with a total of 148 available isolates recovered from 146 patients. Most (n = 144; 97.2%) isolates presented a PRA-hsp65 restriction pattern suggestive of Mycobacterium bolletii or Mycobacterium massiliense. Seventy-four of these isolates were further identified by hsp65 or rpoB partial sequencing, confirming the species identification as M. massiliense. Epidemic isolates showed susceptibility to amikacin (MIC at which 90% of the tested isolates are inhibited [MIC(90)], 8 microg/ml) and clarithromycin (MIC(90), 0.25 microg/ml) but resistance to ciprofloxacin (MIC(90), >or=32 microg/ml), cefoxitin (MIC(90), 128 microg/ml), and doxycycline (MIC(90), >or=64 microg/ml). Representative epidemic M. massiliense isolates that were randomly selected, including at least one isolate from each hospital where confirmed cases were detected, belonged to a single clone, as indicated by the analysis of pulsed-field gel electrophoresis (PFGE) patterns. They also had the same PFGE pattern as that previously observed in two outbreaks that occurred in other Brazilian cities; we designated this clone BRA100. All five BRA100 M. massiliense isolates tested presented consistent tolerance to 2% glutaraldehyde. This is the largest epidemic of postsurgical infections caused by RGM reported in the literature to date in Brazil.
authors.affiliation: Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. rsduarte@ufrj.br
authors.forename: Rafael Silva
authors.initials: RS
authors.lastname: Duarte
authors.forename: Maria Cristina Silva
authors.initials: MC
authors.lastname: Lourenço
authors.forename: Leila de Souza
authors.initials: Lde S
authors.lastname: Fonseca
authors.forename: Sylvia Cardoso
authors.initials: SC
authors.lastname: Leão
authors.forename: Efigenia de Lourdes T
authors.initials: Ede L
authors.lastname: Amorim
authors.forename: Ingrid L L
authors.initials: IL
authors.lastname: Rocha
authors.forename: Fabrice Santana
authors.initials: FS
authors.lastname: Coelho
authors.forename: Cristina
authors.initials: C
authors.lastname: Viana-Niero
authors.forename: Karen Machado
authors.initials: KM
authors.lastname: Gomes
authors.forename: Marlei Gomes
authors.initials: MG
authors.lastname: da Silva
authors.forename: Nádia Suely de Oliveira
authors.initials: NS
authors.lastname: Lorena
authors.forename: Marcos Bettini
authors.initials: MB
authors.lastname: Pitombo
authors.forename: Rosa M C
authors.initials: RM
authors.lastname: Ferreira
authors.forename: Márcio Henrique de Oliveira
authors.initials: MH
authors.lastname: Garcia
authors.forename: Gisele Pinto
authors.initials: GP
authors.lastname: de Oliveira
authors.forename: Otilia
authors.initials: O
authors.lastname: Lupi
authors.forename: Bruno Rios
authors.initials: BR
authors.lastname: Vilaça
authors.forename: Lúcia Rodrigues
authors.initials: LR
authors.lastname: Serradas
authors.forename: Alberto
authors.initials: A
authors.lastname: Chebabo
authors.forename: Elizabeth Andrade
authors.initials: EA
authors.lastname: Marques
authors.forename: Lúcia Martins
authors.initials: LM
authors.lastname: Teixeira
authors.forename: Margareth
authors.initials: M
authors.lastname: Dalcolmo
authors.forename: Simone Gonçalves
authors.initials: SG
authors.lastname: Senna
authors.forename: Jorge Luiz Mello
authors.initials: JL
authors.lastname: Sampaio
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D001938:Brazil / Q000453:epidemiology; D018834:Chaperonin 60; D018833:Chaperonins / Q000235:genetics; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D009161:Mycobacterium / Q000145:classification / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000453:epidemiology* / Q000382:microbiology; D017422:Sequence Analysis, DNA; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D001426:Bacterial Proteins; D018834:Chaperonin 60; D004269:DNA, Bacterial; C074119:heat-shock protein 65, Mycobacterium; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit; D018833:Chaperonins