title: Risk Factors for Mycobacterium abscessus subsp. bolletii infection after laparoscopic surgery during an outbreak in Brazil.
abstract: OBJECTIVE To identify risk factors related to Mycobacterium abscessus subsp. bolletii infection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases. DESIGN A retrospective cohort study. SETTING A private hospital in Manaus, Brazil. PATIENTS A cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team. METHODS We collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables with P≤0.2 in the bivariate analysis in a logistic regression model. Additionally, we reviewed the procedures for reprocessing the laparoscopic surgery equipment, and the strains obtained with culture were identified by molecular methods. RESULTS We recorded 60 (27%) cases of infection. After multivariate analysis, the duration of surgery beyond 1 hour (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2-4.5), not to have been the first operated patient on a given day (OR, 2.7; 95% CI, 1.4-5.2), and the use of permanent trocar (OR, 2.2; 95% CI, 1.1-4.2) were associated with infection. We observed that the surgical team attempted to sterilize the equipment in glutaraldehyde solution when sanitary authorities had already prohibited it. Eleven strains presented 100% DNA identity with a single strain, known as BRA100 clone. CONCLUSIONS Because contaminated material can act as vehicle for infection, ensuring adequate sterilization processing of video-assisted surgery equipment was crucial to stopping this single clonal outbreak of nonturbeculous mycobacteria in Brazil.
authors: 1Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde - EPISUS - 2010-2012 (Field Epidemiology Training Program - FETP),Secretaria de Vigilância em Saúde,Ministério da Saúde,Brasilia,Distrito Federal,Brazil.
authors: Gabriela
authors: G
authors: Baruque Villar
authors: 2Núcleo de Medicina Tropical,Universidade de Brasília,Brasilia,Distrito Federal,Brazil.
authors: Felipe Teixeira
authors: FT
authors: de Mello Freitas
authors: 3Centro de Referência Professor Hélio Fraga,Escola Nacional de Saúde Pública,Fundação Oswaldo Cruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors: Jesus
authors: J
authors: Pais Ramos
authors: 3Centro de Referência Professor Hélio Fraga,Escola Nacional de Saúde Pública,Fundação Oswaldo Cruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors: Carlos Eduardo
authors: CE
authors: Dias Campos
authors: 3Centro de Referência Professor Hélio Fraga,Escola Nacional de Saúde Pública,Fundação Oswaldo Cruz,Rio de Janeiro,Rio de Janeiro,Brazil.
authors: Paulo Cesar
authors: PC
authors: de Souza Caldas
authors: 1Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde - EPISUS - 2010-2012 (Field Epidemiology Training Program - FETP),Secretaria de Vigilância em Saúde,Ministério da Saúde,Brasilia,Distrito Federal,Brazil.
authors: Fernanda
authors: F
authors: Santos Bordalo
authors: 4Comissão Estadual de Controle de Infecção hospitalar,Fundação de Vigilância em Saúde,Manaus,Amazonas,Brazil.
authors: Tatyana Costa
authors: TC
authors: Amorim Ramos
authors: 4Comissão Estadual de Controle de Infecção hospitalar,Fundação de Vigilância em Saúde,Manaus,Amazonas,Brazil.
authors: Vívian
authors: V
authors: do Nascimento Pereira
authors: 5Fundação de Medicina Tropical Dr. Heitor Vieira Dourado,Universidade do Estado do Amazonas,Manaus,Amazonas,Brazil.
authors: Marcelo
authors: M
authors: Cordeiro-Santos
authors: 5Fundação de Medicina Tropical Dr. Heitor Vieira Dourado,Universidade do Estado do Amazonas,Manaus,Amazonas,Brazil.
authors: Joao Hugo
authors: JH
authors: Abdalla Santos
authors: 6Laboratório Central de Saúde Pública do Amazonas,Fundação de Vigilância em Saúde,Manaus,Amazonas,Brazil.
authors: Glauco
authors: G
authors: Coelho Motta
authors: 7Brazillian Sanitary Agency (Agência Nacional de Vigilância Sanitária),Brasilia,Distrito Federal,Brazil.
authors: Suzie Marie
authors: SM
authors: Gomes
authors: 1Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde - EPISUS - 2010-2012 (Field Epidemiology Training Program - FETP),Secretaria de Vigilância em Saúde,Ministério da Saúde,Brasilia,Distrito Federal,Brazil.
authors: Verena Maria
authors: VM
authors: Mendes de Souza
authors: 1Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde - EPISUS - 2010-2012 (Field Epidemiology Training Program - FETP),Secretaria de Vigilância em Saúde,Ministério da Saúde,Brasilia,Distrito Federal,Brazil.
authors: Wildo Navegantes
authors: WN
authors: de Araujo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D004196:Disease Outbreaks; D004202:Disinfectants; D004203:Disinfection / Q000592:standards*; D005260:Female; D005976:Glutaral; D019983:Guideline Adherence; D016304:Hospitals, Private; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D016926:Mycobacterium chelonae / Q000145:classification / Q000235:genetics; D012189:Retrospective Studies; D012307:Risk Factors; D013525:Surgical Instruments / Q000009:adverse effects / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D004202:Disinfectants; D005976:Glutaral