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.
Leão
Sylvia Cardoso
SC
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
Viana-Niero
Cristina
C
Matsumoto
Cristianne Kayoko
CK
Lima
Karla Valeria Batista
KV
Lopes
Maria Luiza
ML
Palaci
Moisés
M
Hadad
David Jamil
DJ
Vinhas
Solange
S
Duarte
Rafael Silva
RS
Lourenço
Maria Cristina Silva
MC
Kipnis
André
A
das Neves
Zilah Cândida
ZC
Gabardo
Betina Mendez Alcântara
BM
Ribeiro
Marta Osório
MO
Baethgen
Ludmila
L
de Assis
Denise Brandão
DB
Madalosso
Geraldine
G
Chimara
Erica
E
Dalcolmo
Margareth Pretti
MP
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