Epidemic of surgical-site infections by a single clone of rapidly growing mycobacteria in Brazil.
OBJECTIVE
Our aim is to investigate if the clusters of postsurgical mycobacterial infections, reported between 2004 and 2008 in seven geographically distant states in Brazil, were caused by a single mycobacterial strain.


METHODS
Available information from 929 surgical patients was obtained from local health authorities. A total of 152 isolates from surgical patients were identified by PCR restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene. Isolates were typed by pulsed-field gel electrophoresis (PFGE) using two restriction enzymes, DraI and AseI. A total of 15 isolates not related to surgical cases were analyzed for comparison.


RESULTS
All isolates were identified as Mycobacterium abscessus ssp. massiliense. Isolates from surgical patients and one sputum isolate grouped in a single PFGE cluster, composed of two closely related patterns, with one band difference. A total of 14 other isolates unrelated to surgical cases showed distinctive PFGE patterns.


CONCLUSIONS
A particular strain of M. abscessus ssp. massiliense was associated with a prolonged epidemic of postsurgical infections in seven Brazilian states, suggesting that this strain may be distributed in Brazilian territory and better adapted to cause surgical-site infections.
Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, Rua Botucatu, 862 3 degrees Andar, 04023-062 - São Paulo, SP, Brazil. sylvia.leao@unifesp.br
Sylvia Cardoso
SC
Leão
Cristina
C
Viana-Niero
Cristianne Kayoko
CK
Matsumoto
Karla Valeria Batista
KV
Lima
Maria Luiza
ML
Lopes
Moisés
M
Palaci
David Jamil
DJ
Hadad
Solange
S
Vinhas
Rafael Silva
RS
Duarte
Maria Cristina Silva
MC
Lourenço
André
A
Kipnis
Zilah Cândida
ZC
das Neves
Betina Mendez Alcântara
BM
Gabardo
Marta Osório
MO
Ribeiro
Ludmila
L
Baethgen
Denise Brandão
DB
de Assis
Geraldine
G
Madalosso
Erica
E
Chimara
Margareth Pretti
MP
Dalcolmo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D001938:Brazil / Q000453:epidemiology; D002648:Child; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology*; D016172:DNA Fingerprinting; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009161:Mycobacterium / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult