Epidemic of postsurgical infections caused by Mycobacterium massiliense.
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.
Duarte
Rafael Silva
RS
Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. rsduarte@ufrj.br
Lourenço
Maria Cristina Silva
MC
Fonseca
Leila de Souza
Lde S
Leão
Sylvia Cardoso
SC
Amorim
Efigenia de Lourdes T
Ede L
Rocha
Ingrid L L
IL
Coelho
Fabrice Santana
FS
Viana-Niero
Cristina
C
Gomes
Karen Machado
KM
da Silva
Marlei Gomes
MG
Lorena
Nádia Suely de Oliveira
NS
Pitombo
Marcos Bettini
MB
Ferreira
Rosa M C
RM
Garcia
Márcio Henrique de Oliveira
MH
de Oliveira
Gisele Pinto
GP
Lupi
Otilia
O
Vilaça
Bruno Rios
BR
Serradas
Lúcia Rodrigues
LR
Chebabo
Alberto
A
Marques
Elizabeth Andrade
EA
Teixeira
Lúcia Martins
LM
Dalcolmo
Margareth
M
Senna
Simone Gonçalves
SG
Sampaio
Jorge Luiz Mello
JL
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
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