title: Management of Mycobacterium abscessus Infection After Medical Tourism in Cosmetic Surgery and a Review of Literature.
abstract: BACKGROUND
  Despite news reports, Food and Drug Administration disclaimers, and warnings from US plastic surgeons against the perils of cosmetic tourism, patients continue to seek care abroad and often present with infectious complications. Recent reports of Mycobacterium abscessus surgical site infection (SSI) is of particularly concern and its management, particularly surgical intervention, has been poorly documented.
  
  
  METHODS
  A retrospective review of 2 sisters who presented with M. abscessus SSI after cosmetic surgery in the Dominican Republic was performed. A comprehensive review of the literature was conducted to unveil similar cases after cosmetic tourism.
  
  
  RESULTS
  Both patients presented four months after index operation after definitive diagnoses have been reached. They were counselled to undergo immediate, aggressive debridement and antibiotic therapy. Although 1 patient agreed, the other patient opted for local wound care and oral antibiotics in hopes to avoid reoperation. When unsuccessful, she agreed to the initial plan which led to rapid convalescence of her infection. However, aesthetic result was far inferior to the first patient. Review of literature revealed 14 women with an average age of 40 years (range, 19-60 years). Most frequent cosmetic operations that resulted in M. abscessus SSI were abdominoplasty (41%), liposuction (27%), breast augmentation (14%), breast reduction (9%), and rejuvenation surgery (9%). Surgical interventions were performed in all cases except one. Antibiotic therapies focused on macrolides, particularly clarithromycin or azithromycin, with average time to complete recovery of 8 months (range, 2-22 months).
  
  
  CONCLUSIONS
  The 2 cases highlighted the importance of multidisciplinary approach of early aggressive surgical intervention and long-term intravenous antibiotics in treating M. abscessus SSI that is highly prevalent among those returning from medical tourism in cosmetic surgery.
authors.affiliation: From the *Division of Plastic Surgery, University of Maryland School of Medicine; †Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cai
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lifchez
mesh_terms: D000328:Adult; D003357:Cosmetic Techniques; D004293:Dominican Republic; D005260:Female; D006801:Humans; D057193:Medical Tourism; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000628:therapy