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Nguyen MVH, Hasan NA, De Moura VCN, Epperson LE, Czaja CA, Johnston H, Laramee N, Orten K, Rivas J, Prasai S, Grossman MK, Perkins KM, Griffith DE, Khare R, Strong M, Daley CL. Notes from the Field: Potential Outbreak of Extrapulmonary Mycobacterium abscessus subspecies massiliense Infections from Stem Cell Treatment Clinics in Mexico - Arizona and Colorado, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:420-422. [PMID: 38722805 PMCID: PMC11095943 DOI: 10.15585/mmwr.mm7318a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Mycobacterium abscessus is an intrinsically drug-resistant, rapidly growing, nontuberculous mycobacterium; extrapulmonary infections have been reported in association with medical tourism (1). During November-December 2022, two Colorado hospitals (hospitals A and B) treated patient A, a Colorado woman aged 30-39 years, for M. abscessus meningitis. In October 2022, she had received intrathecal donor embryonic stem cell injections in Baja California, Mexico to treat multiple sclerosis and subsequently experienced headaches and fevers, consistent with meningitis. Her cerebrospinal fluid revealed neutrophilic pleocytosis and grew M. abscessus in culture at hospital A. Hospital A's physicians consulted hospital B's infectious diseases (ID) physicians to co-manage this patient (2).
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2
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Alkaelani MT, Koussayer B, Blount T, Amawi YA, Mahboob O, Le NK, Parus A, Troy J. Complications of Medical Tourism in Aesthetic Surgery: A Systematic Review. Ann Plast Surg 2023; 91:668-673. [PMID: 37962261 DOI: 10.1097/sap.0000000000003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
INTRODUCTION As medical cost continues to rise, so has the use of medical tourism by patients as a more cost-effective alternative. While the upfront cost savings attract many unsuspecting patients from their country of origin, there are significant patient safety issues surrounding short- and long-term follow-up, as well as the management and cost of complications. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses on complications that presented after cosmetic surgeries performed abroad. The literature search was performed on October 18, 2022, using the databases of PubMed, Google Scholar, and Embase. RESULTS From the 44 studies that were included, 589 patients were identified who presented with complications after having a cosmetic procedure abroad. Infection was the most prevalent complication in this study followed by wound dehiscence, seroma/hematoma, and tissue necrosis. Ninety-eight percent of the infectious organisms were bacterial, and 81% of them were from the Mycobacterium genus. CONCLUSIONS Cosmetic tourism is a global phenomenon. This systematic review highlights the nature of complications following cosmetic tourism, the surgeries that resulted in complications, the countries that the primary procedures took place in, and the countries of origin of the patients. To aid in reducing morbidity and mortality from cosmetic tourism, regulatory bodies should educate and empower the public to aid them in making educated medical conditions when seeking care.
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Affiliation(s)
| | - Bilal Koussayer
- Department of Plastic Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Taylor Blount
- From the Florida State University College of Medicine
| | - Yusuf A Amawi
- From the Florida State University College of Medicine
| | - Omar Mahboob
- From the Florida State University College of Medicine
| | - Nicole K Le
- Department of Plastic Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Anamaria Parus
- Department of Plastic Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL
| | - Jared Troy
- Department of Plastic Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL
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Gilardi R, Galassi L, Del Bene M, Firmani G, Parisi P. Infective complications of cosmetic tourism: A systematic literature review. J Plast Reconstr Aesthet Surg 2023; 84:9-29. [PMID: 37320953 DOI: 10.1016/j.bjps.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/16/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cosmetic tourism has increased dramatically over the years. We performed a systematic review of the literature to find reports of infective complications following cosmetic surgery, focusing on epidemiology, clinical, and surgical management. In addition, we identified cosmetic tourism trends in terms of mobilization from the country of origin and travel destinations. METHODS A search on PubMed, Embase, and Web of Science was performed between March and August 2022. The search was not restricted based on study date. Only English manuscripts were assessed. Reviews, short communications, letters, and correspondences were excluded after reviewing their references for potentially relevant studies. Articles related to non-cosmetic surgeries were also excluded from the study. RESULTS We identified 152 articles, of which 31 were duplicates and 47 were excluded based on title/abstract assessment. Three non-English manuscripts, 13 reviews, 12 letters to the editor, and 10 articles that did not feature clinical cases were also rejected. Thirty-six articles were included for analysis. We found 370 patients with infective complications following cosmetic surgery. The severity of complications was stratified according to the Clavien-Dindo classification. Most reports were from the United States (56.5%), followed by Switzerland and the United Kingdom. Travel destinations included the Dominican Republic (34.3%), Turkey, and Colombia. CONCLUSION Infective complications commonly occurred after abdominoplasties in patients who underwent cosmetic surgeries in Latin America or Asia. Most infective complications required management with surgical procedures that involved the administration of local, regional, or general anesthesia. Gluteal augmentations were the fourth most common cosmetic procedures; however, they were associated with the highest number of severe cases, which required intensive care treatment.
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Affiliation(s)
- Roberta Gilardi
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Luca Galassi
- Division of Vascular Surgery, San Gerardo Hospital of Monza, Italy
| | - Massimo Del Bene
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome - Department of Plastic Surgery Sant'Andrea Hospital, Rome, Italy
| | - Paola Parisi
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS Rome, Italy.
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Wolf AB, Money KM, Chandnani A, Daley CL, Griffith DE, Chauhan L, Coffman N, Piquet AL, Tyler KL, Zimmer SM, Montague BT, Mann S, Pastula DM. Mycobacterium abscessus Meningitis Associated with Stem Cell Treatment During Medical Tourism. Emerg Infect Dis 2023; 29:1655-1658. [PMID: 37486227 PMCID: PMC10370854 DOI: 10.3201/eid2908.230317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Mycobacterium abscessus infections have been reported as adverse events related to medical tourism. We report M. abscessus meningitis in a patient who traveled from Colorado, USA, to Mexico to receive intrathecal stem cell injections as treatment for multiple sclerosis. We also review the management of this challenging central nervous system infection.
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Beech AJ, Weinberg SE, Mortimer AE, Lynch F, Bedford J, Calisti G. Mycobacterium abscessus skin and soft tissue infection following autologous fat grafting in Kurdistan treated with an antibiotic combination including Imipenem-Relebactam and Rifabutin. J Clin Tuberc Other Mycobact Dis 2023; 32:100381. [PMID: 37323244 PMCID: PMC10267594 DOI: 10.1016/j.jctube.2023.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Medical tourism is becoming increasingly popular. The most popularly sought operations are cosmetic procedures. With the increase in cosmetic tourism, it is unsurprising that there has also been a rise in skin and soft tissue infections caused by nontuberculous mycobacteria (NTM); in particular by the rapidly growing mycobacteria species. Here we provide a case of a 35 year-old woman who presented after autologous fat grafting with multiple painful, violaceous, and purulent nodules on her arms, legs, and breasts. Infection was found to be due to Mycobacterium abscessus. She was successfully treated with azithromycin, clofazimine, rifabutin, amikacin, imipenem-cilastatin-relebactam (Recarbrio™) and imipenem-cilastatin. This is the first described case of a M. abscessus infection successfully treated using this combination.
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Affiliation(s)
- Alison J. Beech
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
| | - Sharon E. Weinberg
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
| | - Alice E. Mortimer
- Department of Plastic Surgery and Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, Manchester, United Kingdom
| | - Fiona Lynch
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
| | - James Bedford
- Department of Plastic Surgery and Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, Manchester, United Kingdom
| | - Giorgio Calisti
- Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, United Kingdom
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Baker AW, Maged A, Haridy S, Stout JE, Seidelman JL, Lewis SS, Anderson DJ. Use of Statistical Process Control Methods for Early Detection of Healthcare Facility-Associated Nontuberculous Mycobacteria Outbreaks: A Single-Center Pilot Study. Clin Infect Dis 2023; 76:1459-1467. [PMID: 36444485 PMCID: PMC10319764 DOI: 10.1093/cid/ciac923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are emerging pathogens increasingly implicated in healthcare facility-associated (HCFA) infections and outbreaks. We analyzed the performance of statistical process control (SPC) methods in detecting HCFA NTM outbreaks. METHODS We retrospectively analyzed 3 NTM outbreaks that occurred from 2013 to 2016 at a tertiary care hospital. The outbreaks consisted of pulmonary Mycobacterium abscessus complex (MABC) acquisition, cardiac surgery-associated extrapulmonary MABC infection, and a bronchoscopy-associated pseudo-outbreak of Mycobacterium avium complex (MAC). We analyzed monthly case rates of unique patients who had positive respiratory cultures for MABC, non-respiratory cultures for MABC, and bronchoalveolar lavage cultures for MAC, respectively. For each outbreak, we used these rates to construct a pilot moving average (MA) SPC chart with a rolling baseline window. We also explored the performance of numerous alternative control charts, including exponentially weighted MA, Shewhart, and cumulative sum charts. RESULTS The pilot MA chart detected each outbreak within 2 months of outbreak onset, preceding actual outbreak detection by an average of 6 months. Over a combined 117 months of pre-outbreak and post-outbreak surveillance, no false-positive SPC signals occurred (specificity, 100%). Prospective use of this chart for NTM surveillance could have prevented an estimated 108 cases of NTM. Six high-performing alternative charts detected all outbreaks during the month of onset, with specificities ranging from 85.7% to 94.9%. CONCLUSIONS SPC methods have potential to substantially improve HCFA NTM surveillance, promoting early outbreak detection and prevention of NTM infections. Additional study is needed to determine the best application of SPC for prospective HCFA NTM surveillance in other settings.
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Affiliation(s)
- Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Ahmed Maged
- Department of Advanced Design and Systems Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Mechanical Engineering, Benha University, Benha, Egypt
| | - Salah Haridy
- Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, United Arab Emirates
- Benha Faculty of Engineering, Benha University, Benha, Egypt
| | - Jason E Stout
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica L Seidelman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Sarah S Lewis
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
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Guidance on the treatment of rare deep subcutaneous mycobacterium abscess following cosmetic procedures: a case series and systematic review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Waletzko B, Lin PL, Lopez SMC. "Hot Tub Lung" With M. avium complex in an Immunocompetent Adolescent. Pediatr Infect Dis J 2023; 42:e84-e87. [PMID: 36729986 DOI: 10.1097/inf.0000000000003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a case of pulmonary Mycobacterium avium complex (MAC) infection in an immunocompetent pediatric patient after a hot tub near drowning event with a literature review of pediatric MAC-associated disease after hot tub exposure.
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Affiliation(s)
- Benjamin Waletzko
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Santiago M C Lopez
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota
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Klompas M, Akusobi C, Boyer J, Woolley A, Wolf ID, Tucker R, Rhee C, Fiumara K, Pearson M, Morris CA, Rubin E, Baker MA. Mycobacterium abscessus Cluster in Cardiac Surgery Patients Potentially Attributable to a Commercial Water Purification System. Ann Intern Med 2023; 176:333-339. [PMID: 36877966 DOI: 10.7326/m22-3306] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Nontuberculous mycobacteria are water-avid pathogens that are associated with nosocomial infections. OBJECTIVE To describe the analysis and mitigation of a cluster of Mycobacterium abscessus infections in cardiac surgery patients. DESIGN Descriptive study. SETTING Brigham and Women's Hospital, Boston, Massachusetts. PARTICIPANTS Four cardiac surgery patients. INTERVENTION Commonalities among cases were sought, potential sources were cultured, patient and environmental specimens were sequenced, and possible sources were abated. MEASUREMENTS Description of the cluster, investigation, and mitigation. RESULTS Whole-genome sequencing confirmed homology among clinical isolates. Patients were admitted during different periods to different rooms but on the same floor. There were no common operating rooms, ventilators, heater-cooler devices, or dialysis machines. Environmental cultures were notable for heavy mycobacterial growth in ice and water machines on the cluster unit but little or no growth in ice and water machines in the hospital's other 2 inpatient towers or in shower and sink faucet water in any of the hospital's 3 inpatient towers. Whole-genome sequencing confirmed the presence of a genetically identical element in ice and water machine and patient specimens. Investigation of the plumbing system revealed a commercial water purifier with charcoal filters and an ultraviolet irradiation unit leading to the ice and water machines in the cluster tower but not the hospital's other inpatient towers. Chlorine was present at normal levels in municipal source water but was undetectable downstream from the purification unit. There were no further cases after high-risk patients were switched to sterile and distilled water, ice and water machine maintenance was intensified, and the commercial purification system was decommissioned. LIMITATION Transmission pathways were not clearly characterized. CONCLUSION Well-intentioned efforts to modify water management systems may inadvertently increase infection risk for vulnerable patients. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine and Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Chidiebere Akusobi
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (C.A., I.D.W.)
| | - Jon Boyer
- Department of Environmental Affairs, Brigham and Women's Hospital, Boston, Massachusetts (J.B.)
| | - Ann Woolley
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.W., C.A.M.)
| | - Ian D Wolf
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (C.A., I.D.W.)
| | - Robert Tucker
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts (R.T., K.F.)
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine and Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Karen Fiumara
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts (R.T., K.F.)
| | - Madelyn Pearson
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts (M.P.)
| | - Charles A Morris
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.W., C.A.M.)
| | - Eric Rubin
- Department of Medicine, Brigham and Women's Hospital, and Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (E.R.)
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine and Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
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10
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High Morbidity of Mycobacterial Infections Following Cosmetic Surgery Tourism. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Groenewold MR, Flinchum A, Pillai A, Konkle S, Moulton-Meissner H, Tosh PK, Thoroughman DA. Investigation of a cluster of rapidly growing mycobacteria infections associated with joint replacement surgery in a Kentucky hospital, 2013-2014 with 8-year follow-up. Am J Infect Control 2022; 51:454-460. [PMID: 35732255 PMCID: PMC9896514 DOI: 10.1016/j.ajic.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND We describe the investigation of a nosocomial outbreak of rapidly growing mycobacteria (RGM) infections and the results of mitigation efforts after 8 years. METHODS A cluster of RGM cases in a Kentucky hospital in 2013 prompted an investigation into RGM surgical site infections following joint replacement surgery. A case-control study was conducted to identify risk factors. RESULTS Eight cases were identified, 5 caused by M. wolinskyi and 3 by M. goodii. The case-control study showed the presence of a particular nurse in the operating room was significantly associated with infection. Environmental sampling at the nurse's home identified an outdoor hot tub as the likely source of M. wolinskyi, confirmed by pulsed-field gel electrophoresis and whole genome sequencing. The hot tub reservoir was eliminated, and hospital policies were revised to correct infection control lapses. No new cases of RGM infections have been identified as of 2021. DISCUSSION Breaches in infection control practices at multiple levels may have led to a chain of infection from a nurse's hot tub to surgical sites via indirect person-to-person transmission from a colonized health care worker (HCW). CONCLUSIONS The multifactorial nature of the outbreak's cause highlights the importance of overlapping or redundant layers of protection preventing patient harm. Future investigations of RGM outbreaks should consider the potential role of colonized HCWs as a transmission vector.
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Affiliation(s)
- Matthew R. Groenewold
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Frankfort, KY, USA,Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA,Address correspondence to Matthew R. Groenewold, PhD, MSPH, Centers for Disease Control and Prevention, NIOSH, 1090 Tusculum Ave. MS R-17, Cincinnati, OH 45226.
| | - Andrea Flinchum
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
| | - Aravind Pillai
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
| | - Stacey Konkle
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pritish K. Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Douglas A. Thoroughman
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Frankfort, KY, USA,Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
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Robinson PD, Vaughan S, Missaghi B, Meatherall B, Pattullo A, Kuhn S, Conly J. A case series of infectious complications in medical tourists requiring hospital admission or outpatient home parenteral therapy. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:64-74. [PMID: 36340853 PMCID: PMC9603019 DOI: 10.3138/jammi-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Travelling for medical care is increasing, and this medical tourism (MT) may have complications, notably infectious diseases (ID). We sought to identify MT-related infections (MTRIs) in a large Canadian health region and estimate resulting costs. METHODS Retrospective and prospective capture of post-MT cases requiring hospital admission or outpatient parenteral antimicrobial therapy was completed by canvassing ID physicians practising in Calgary, Alberta, from January 2017 to July 2019. Cost estimates for management were made with the Canadian Institute for Health Information's (CIHI's) patient cost estimator database tool applied to estimated rates of Canadians engaging in MT from a 2017 Fraser Institute report. RESULTS We identified 12 cases of MT-related infectious syndromes. Eight had microbial etiologies identified. MTs were young (mean 40.3 [SD 12.2] y) and female (n = 11) and pursued surgical treatment (n = 11). Destination countries and surgical procedures varied but were largely cosmetic (n = 5) and orthopaedic (n = 3). Duration to organism identification (mean 5.3 wk) and treatment courses (mean 19 wk) appeared lengthy. CIHI cost estimates for management of relevant infectious complications of our cases ranged from $6,288 to $20,741, with total cost for cases with matching codes (n = 8) totalling $94,290. CONCLUSIONS In our series of MTRIs, etiologic organisms often found in Canadian-performed post-procedural infections were identified, and prolonged treatment durations were noted. Young women pursuing cosmetic surgery may be a population to target with public health measures to reduce the incidence of MTRIs and burden of disease.
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Affiliation(s)
- Paul D Robinson
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie Meatherall
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Andrew Pattullo
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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13
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Vongthilath-Moeung R, Plojoux J, Poncet A, Renzi G, Veziris N, Schrenzel J, Janssens JP. Nontuberculous Mycobacteria under Scrutiny in the Geneva Area (2015-2020). Respiration 2021; 101:367-375. [PMID: 34875659 DOI: 10.1159/000520033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are increasingly identified in industrialized countries, and their role as pathogens is more frequently recognized. The relative prevalence of NTM strains shows an important geographical variability. Thus, establishing the local relative prevalence of NTM strains is relevant and useful for clinicians. METHODS Retrospective analysis (2015-2020) of a comprehensive database was conducted including all results of cultures for mycobacteria in a University Hospital (Geneva, Switzerland), covering a population of approximately 500,000 inhabitants. All NTM culture-positive patients were included in the analyses. Patients' characteristics, NTM strains, and time to culture positivity were reported. RESULTS Among 38,065 samples analyzed during the study period, 411 were culture-positive for NTM, representing 236 strains, and 231 episodes of care which occurred in 222 patients. Patients in whom NTM were identified were predominantly female (55%), with a median age of 62 years, and a low BMI (median: 22.6 kg/m2). The Mycobacterium avium complex (MAC) was the most frequently identified group (37% of strains) followed by Mycobacterium gordonae (25%) and Mycobacterium xenopi (12%) among the slowly growing mycobacteria (SGM), while the Mycobacterium chelonae/abscessus group (11%) were the most frequently identified rapidly growing mycobacteria (RGM). Only 19% of all patients were treated, mostly for pulmonary infections: the MAC was the most frequently treated NTM (n = 19, 43% of cases in patients treated) followed by RGM (n = 15, 34%) and M. xenopi (n = 6, 14%). Among those treated, 23% were immunosuppressed, 12% had pulmonary comorbidities, and 5% systemic comorbidities. Cultures became positive after a median of 41 days (IQR: 23; 68) for SGM and 28 days (14; 35) for RGM. CONCLUSIONS In Western Switzerland, M. avium and M. gordonae were the most prevalent NTM identified. Positive cultures for NTM led to a specific treatment in 19% of subjects. Patients with a positive culture for NTM were mostly female, with a median age of 62 years, a low BMI, and a low prevalence of immunosuppression or associated severe comorbidities.
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Affiliation(s)
- Rechana Vongthilath-Moeung
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland,
| | - Jérôme Plojoux
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Poncet
- Center for Clinical Research & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Gesuele Renzi
- Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Veziris
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR 1135, Département de Bactériologie, Hôpital Saint-Antoine, Centre National de Référence des Mycobactéries, APHP. Sorbonne Université, Paris, France
| | - Jacques Schrenzel
- Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Population-based surveillance of medical tourism among US residents from 11 states and territories: Findings from the Behavioral Risk Factor Surveillance System. Infect Control Hosp Epidemiol 2021; 43:870-875. [PMID: 34261562 DOI: 10.1017/ice.2021.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe medical tourism among a subset of US residents; identify possible indicators for medical tourism. METHODS The US Centers for Disease Control and Prevention collaborated with 11 states and territories to ask 6 questions about medical tourism, using the Behavioral Risk Factor Surveillance System. Data collected from January 1, 2016, through December 31, 2016, included whether respondents traveled internationally for preplanned care, travel reasons and destinations, procedures received, and occurrence and treatment of complications. A descriptive analysis of demographics, socioeconomic status and health access variables was performed, and a regression model with a log-link function and Poisson distribution was used to estimate prevalence ratios (PR) for medical tourism. RESULTS Of 93,492 respondents, 517 (0.55%) traveled internationally during the previous year for care. Mexico was the most common destination (41% of trips). Dentistry accounted for 55% of treatments. Complications from care received abroad were reported by 5% of medical tourists; 67% sought care upon returning to the United States. The prevalence of medical tourism was 1.32% (95% CI, 1.00-1.64). The prevalence of medical tourism was higher in Hispanics and non-whites (PR, 3.97; 95% CI, 2.48-6.32) and higher among those without current health insurance (PR, 2.70; 95% CI, 1.69-4.34). CONCLUSIONS This is the largest collection of population-based surveillance data describing medical tourism among US residents from multiple states and territories. Understanding the demographic and socioeconomic factors associated with medical tourism can inform evidence-based recommendations for travelers and clinicians who may advise or care for these individuals before, during, or after travel.
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Cutaneous Mycobacterial Infections in Returning Travelers. CURRENT TROPICAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40475-021-00228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Safe IP, Macedo V, Marcelo W, Baia-Da-Silva D, Freitas M, Spener R, Oliveira V, De Jesus J, Lacerda M, Cordeiro-Santos M. Nontuberculous Mycobacterial Infections after Aesthetic Procedures: Comparison of Clinical Features and Treatment. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:46-49. [PMID: 33841617 PMCID: PMC8021410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nontuberculous mycobacteria (NTM) have been increasingly identified as causative of numerous cosmetic procedure related infections worldwide. This manuscript reports clinical aspects and antimicrobial resistance profiles of NTM infections associated with aesthetic procedures diagnosed in a private infectious disease clinic in the Brazilian Amazon. Four patients developed skin and soft tissue infections between August 2015 and August 2019. Clinical, microbiological, and epidemiological data were collected. M. conceptionense, M. abscessus and M. fortuitum were isolated. The histopathology showed dermal granulomatous inflammation. All patients were treated with a combination of antimycobacterial regimens, mainly with moxifloxacin and clarithromycin.
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Affiliation(s)
- Izabella Picinin Safe
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Viviane Macedo
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Wuelton Marcelo
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Djane Baia-Da-Silva
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Monique Freitas
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Renata Spener
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Victor Oliveira
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Jaquelane De Jesus
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Marcus Lacerda
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
| | - Marcelo Cordeiro-Santos
- Drs. Safe, Macedo, Baia-da-Silva, Santana, Spener, Moraes, de Jesus, Lacerda, and Cordeiro-Santos are with the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas, Brazil
- Drs. Safe, Monteiro, Santana, Spener, Moraes, Lacerda, and Cordeiro-Santos are with the Universidade do Estado do Amazonas in Manaus, Amazonas, Brazil
- Drs. Safe, Moraes, Lacerda, and Cordeiro-Santos are with Clínica de Infectologia de Manaus in Amazonas, Brazil
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Pavli A, Maltezou HC. Infectious complications related to medical tourism. J Travel Med 2021; 28:5959955. [PMID: 33159509 DOI: 10.1093/jtm/taaa210] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. METHODS A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. RESULTS The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. CONCLUSIONS There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Profiles of Extrapulmonary Nontuberculous Mycobacteria Infections and Predictors for Species: A Multicenter Retrospective Study. Pathogens 2020; 9:pathogens9110949. [PMID: 33202553 PMCID: PMC7697751 DOI: 10.3390/pathogens9110949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/15/2023] Open
Abstract
Extrapulmonary nontuberculous mycobacteria (NTM) infections contribute to morbidity and mortality worldwide. However, studies about extrapulmonary NTM infections have been limited. Therefore, we aim to describe the diversity of extrapulmonary NTM infections and identify predictors for species. Information regarding diversity of NTM isolates, antimicrobial susceptibility testing, treatment regimens, and outcomes were collected from four tertiary care centers in South Korea. Comparisons were made between patients with rapidly growing mycobacteria (RGM) and slowly growing mycobacteria (SGM) infections. A total of 117 patients (46 males vs. 71 females) were included. Skin and soft tissue infections (SSTIs) predominated (34.2%), followed by bone and joint infections (28.2%). In SSTIs, RGM species were predominantly identified (26/28, 92.9%), whereas SGM species were mainly identified in bone and joint infections (18/26, 69.2%), and the difference of isolated sites was verified by a post hoc test (p < 0.001). Multivariable regression analysis revealed that male sex (vs. female sex; OR 5.30, CI 1.35–24.26, p = 0.020) and bone and joint infections (vs. SSTIs; OR 18.10, CI 3.28–157.07, p = 0.002) were predictors of SGM infections, whereas the opposite was observed for RGM infections. Bone and joint infections and male sex were predictors for SGM infections, whereas SSTIs and female sex were predictors for RGM infections.
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Jhaveri VV, Singhal D, Riedel S, Rowley CF, Nathavitharana RR. Surgical cure of clarithromycin resistant Mycobacterium chelonae breast implant infection: A case report and review of the literature. J Clin Tuberc Other Mycobact Dis 2020; 21:100183. [PMID: 32964146 PMCID: PMC7490846 DOI: 10.1016/j.jctube.2020.100183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Clusters of patients who obtain cosmetic surgeries abroad have developed surgical site infections due to rapid growing non-tuberculous mycobacteria (NTM). These are usually treated with a combination of surgery and months of anti-mycobacterial therapy, but poor outcomes, including permanent scarring are common. We present a case of a 36-year-old female who developed a clarithromycin-resistant M. chelonae (CRMC) infection after undergoing breast augmentation in the Dominican Republic. She underwent debridement and explant of her silicone implants, but due to a series of complications including discordant antimicrobial susceptibility testing profiles, GI side effects, and then pregnancy, she was unable to receive typical multidrug anti-mycobacterial therapy after surgery. She received close clinical follow up and demonstrated full recovery without any evidence of recurrence of infection at 9 months of follow up. We searched the literature for cases of NTM surgical site infection after breast surgery. To our knowledge, this is the first case report of confirmed NTM breast implant infection being cured with surgery alone, and only the second report of clarithromycin resistant M. chelonae in a patient without disseminated infection or pre-exposure to macrolides. The increasing prevalence of drug resistant NTM infections is an emerging concern for clinicians treating patients with complications related to medical tourism.
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Affiliation(s)
- Vimal V. Jhaveri
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Department of Medicine, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Corresponding authors at: Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA, 02215, United States.
| | - Dhruv Singhal
- Harvard Medical School, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery Department of Surgery, United States
| | - Stefan Riedel
- Harvard Medical School, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA, United States
| | - Christopher F. Rowley
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Department of Medicine, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Ruvandhi R. Nathavitharana
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Department of Medicine, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Corresponding authors at: Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA, 02215, United States.
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Taylor J, Vagnone PS, Smith K, Walters J, Wengenack N, Deml S, Ferrieri P, Lynfield R. Characteristics of clinical extrapulmonary nontuberculous mycobacteria isolates in Minnesota, 2013-2017. MINNESOTA MEDICINE 2020; 103:39-43. [PMID: 32831404 PMCID: PMC7437720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Approximately 80 species of nontuberculous mycobacteria (NTM) that cause disease are found environmentally and in animal reservoirs. Typically, pulmonary NTM infections are sporadic; extrapulmonary NTM (ENTM) infections are commonly outbreak associated. Recent sources of ENTM outbreaks in Minnesota include contaminated heater-cooler units used during cardiac surgery and contaminated hormone injections. We examined patient demographics and characteristics of ENTM isolates characterized by four Minnesota reference laboratories during 2013-2017 to assess potential value of systematic laboratory-based ENTM surveillance in Minnesota. Laboratories characterized 490 ENTM isolates, representing an estimated burden of 1.8/100,000 people/year in Minnesota. Thirty-one species or complexes were identified; most common were M. avium complex (31%), M. chelonae (22%), M. fortuitum (11%), and M. abscessus (4%). Most common specimen collection sites included skin and soft tissue (38%), blood (15%), neck lymph node or tissue (12%), sinus (8%), joint or bone (5%), device or implant (4%), and eye (3%). Median age of patients was 55 years (range: 2-98 years); 18% were from patients aged <18 years, 20% aged 18-44 years, 28% aged 45-64 years and 34% aged >65 years. Sex was documented for 238 (49%) patients; 127 (53%) were males. County information was available for 313 patients (64%); approximately half (49%) resided in metropolitan Minneapolis-Saint Paul. Laboratory data can be used for ENTM surveillance in Minnesota. Implementing laboratory-based surveillance can detect ENTM cases, provide a mechanism for obtaining clinical and epidemiological information, and enable earlier identification of potential health care transmission or community clusters.
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Affiliation(s)
- Joanne Taylor
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, and the Minnesota Department of Health
| | - Paula Snippes Vagnone
- Microbiology Laboratory, Infectious Disease Section, State Public Health Laboratory, Minnesota Department of Health
| | - Kirk Smith
- Vectorborne and Zoonotic Diseases Section, Minnesota Department of Health
| | - Jacy Walters
- Healthcare Associated Infections/Antimicrobial Resistance Section, Minnesota Department of Health
| | - Nancy Wengenack
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and professor of Microbiology and Laboratory Medicine and Pathology, Mayo Clinic
| | - Sharon Deml
- Division of Clinical Microbiology, Mayo Clinic
| | - Patricia Ferrieri
- Infectious Diseases Diagnostic Laboratory, University of Minnesota Medical Center, Fairview, and professor of Laboratory Medicine and Pathology, and Pediatrics, University of Minnesota Medical School
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Berndtson AE. Increasing Globalization and the Movement of Antimicrobial Resistance between Countries. Surg Infect (Larchmt) 2020; 21:579-585. [PMID: 32434446 DOI: 10.1089/sur.2020.145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The threat of antimicrobial resistance continues to grow worldwide, exacerbated by poor antibiotic stewardship practices, limited development of new antimicrobial agents, and increasing globalization. Methods: This review covers previously published studies examining how human movement contributes to the global spread of antimicrobial resistance, including between low- and middle-income and high-income countries. Results: The emergence of resistance in one country or part of the world can become a worldwide event quickly. Human movement, including travel, medical tourism, military service, and migration, results in the globalization of resistant bacterial strains. Conclusions: Increased surveillance, whole-genome sequencing, focused infection control, and effective stewardship practices are needed to maintain the efficacy of antibiotics.
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Affiliation(s)
- Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California-San Diego, San Diego, California, USA
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Lopez-Luis BA, Sifuentes-Osornio J, Pérez-Gutiérrez MT, Chávez-Mazari B, Bobadilla-Del-Valle M, Ponce-de-León A. Nontuberculous mycobacterial infection in a tertiary care center in Mexico, 2001-2017. Braz J Infect Dis 2020; 24:213-220. [PMID: 32428442 PMCID: PMC9392119 DOI: 10.1016/j.bjid.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. METHODS We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). RESULTS A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p=0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p=0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p=0.27). CONCLUSIONS Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
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Affiliation(s)
- Bruno Ali Lopez-Luis
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - María Teresa Pérez-Gutiérrez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Bárbara Chávez-Mazari
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Miriam Bobadilla-Del-Valle
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico.
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Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTIs) are among the most common infections in outpatients and the most frequent infectious cause of referrals to emergency departments in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology of SSTIs. RECENT FINDINGS Staphylococcus aureus and streptococci predominate and methicillin-resistant S. aureus (MRSA) poses additional challenges; community-acquired-MRSA in some areas is superseding methicillin-susceptible S. aureus and multidrug resistance is evolving. Incidence data of SSTIs from United States show a decreasing trend, whereas trends of hospitalization rates were increasing. Despite low mortality associated with SSTIs, high rates of treatment failure and relapses are of concern. Diagnosis and management decisions in the emergency department (ED) lack validated tools for prediction of clinical response particularly among elderly, immunocompromised, obese, and patients with comorbidities. A variety of modifiable and nonmodifiable risk factors of the host and data from local epidemiology should be considered to prevent recurrence and treatment failure. SUMMARY An evolving epidemiology of SSTIs make microbiologic documentation and surveillance of local data imperative. New assessment algorithms with potential use in the ED are a priority. The universal applicability of international guidelines is questioned in this setting.
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Abstract
PURPOSE OF REVIEW Nontuberculous mycobacteria (NTM) are emerging pathogens of concern especially in solid organ transplant candidates and recipients. This review aims to address diagnostic challenges, new and emerging treatment options, and infection prevention. RECENT FINDINGS The incidence of NTM infections in transplant candidates and recipients is rising. The infection prevalence of these environmental pathogens varies geographically by species with a coastal predominance. Although existing guidelines from the American Thoracic Society, Infectious Diseases Society of America, and British Thoracic Society provide recommendations for diagnosis and management, they do not fully address the subtle nuances and challenges faced in managing infections in immunocompromised transplant recipients. Evolving data on new therapeutic agents and their use in combination therapy will help individualize treatment regimens while limiting adverse effects and improving compliance. Use of combination β-lactams, avibactam, tedizolid, clofazimine, bedaquiline, liposomal amikacin, and ciprofloxacin for commonly isolated species such as Mycobacterium abscessus and Mycobacterium avium complex have proven effective. SUMMARY Further studies are needed to determine the incidence of NTM infection in a prospective, multicentric manner and evaluate the most promising synergistic treatment combinations in transplant recipients.
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Nontuberculous Mycobacterial Infections After Cosmetic Procedures: A Systematic Review and Management Algorithm. Dermatol Surg 2020; 46:116-121. [PMID: 30964788 DOI: 10.1097/dss.0000000000001929] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nontuberculous mycobacterium (NTM) infection following cosmetic procedures usually results from inadequate sterile techniques and contamination from nonsterile water. These infections are difficult to diagnose and treat. OBJECTIVE This study aimed to describe the characteristics of NTM infections acquired after an aesthetic procedure, identify high-risk patients and high-risk cosmetic procedures, and provide a diagnostic and management algorithm for NTM infections occurring after cosmetic procedures. METHODS On December 20, 2017 an online search of the Medline database was done. All articles describing NTM infection in cosmetic procedures were included in this review. RESULTS In total, 92 patients with a mean age of 38.35 years were included in this review. Cosmetic procedures performed in the Dominican Republic were the most common source of infection and were noted in 33 patients. The procedure that resulted in the highest proportion of the infections was mesotherapy (34%). In most of the cases, the diagnosis was missed at the initial presentation and a short course of inadequate antibiotics was unsuccessful. CONCLUSION Nontuberculous mycobacterium infections are hard to diagnose and difficult to treat, sometimes leading to severe irreversible sequalae. Aesthetic practitioners should know when to suspect and how to prevent, diagnose, and treat NTM infections.
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de la Puente Pacheco MA, de Oro Aguado CM, Lugo Arias E, Fontecha Pacheco B. The Role of Outpatient Care Accreditation in Enhancing Foreign Patients' Perception of Colombian Medical Tourism: A Quasi-experimental Design. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2020; 57:46958020976826. [PMID: 33243056 PMCID: PMC7705782 DOI: 10.1177/0046958020976826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022]
Abstract
This study analyzes whether hospitals accredited by the Joint Commission International in outpatient medical care protocols located in Colombia achieve a higher quality perception from foreign patients compared to others treated in a non-accredited one. A t-test with Welch correction, chi-square test, correlation coefficient of Tau Kendall, pre-test, post-test, complementary questionnaire and a 2 focus groups were used in 178 foreign patients. It was observed that patients treated in accredited hospitals had a higher quality perception than the non-accredited group. However, it was found that an unbalanced application of the 3 variables negatively alters quality judgment. Findings contributes to understanding the Colombian medical tourism in depth using non-conventional instruments.
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Affiliation(s)
| | | | - Elkyn Lugo Arias
- Corporación Universitaria Minuto de
Dios, Uniminuto. Social Development Management Group (DESOGE) of the Economics and
Business Sciences faculty, Barranquilla, Colombia
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27
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Foley BM, Haglin JM, Tanzer JR, Eltorai AEM. Patient care without borders: a systematic review of medical and surgical tourism. J Travel Med 2019; 26:5528799. [PMID: 31281926 DOI: 10.1093/jtm/taz049] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/31/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical tourism (MT) is an increasingly utilized modality for acquiring medical treatment for patients globally. This review assimilates the current literature regarding MT, with particular focus on the applications, ethics and economics. METHODS A systematic review of MEDLINE and PubMed Central databases for publications relating to MT from 2005 to 2018 yielded 43 articles for this review. RESULTS Patients seeking elective bariatric, cosmetic and orthopedic surgery abroad are motivated by significantly lower costs, all-inclusive vacation packages and reduced wait times. Complication rates as high as 56% include infection, poor aesthetic and functional outcome and adverse cardiovascular events. Cross-border reproductive care has steadily increased due to less restrictive policies in select countries; however, the depth of research on outcomes and quality of care is abysmal. Stem cell therapy promise treatments that are often not well researched and offer minimal evidence of efficacy, yet patients are drawn to treatment through anecdotal advertisements and a last sense of hope. Transplant surgery sought to decrease wait times carries many of the similar aforementioned risks and may contribute to the practice of organ trafficking in countries with high rates of poverty. Patients and countries alike are motivated by a plethora of factors to engage in the MT industry but may be doing so without accurate knowledge of the quality, safety or potential for economic gain. Safety is of utmost importance to prevent surgical complications and the spread of treatment-resistant bacteria. CONCLUSIONS MT is growing in popularity and complexity. The lack of standardization in its definition and regulation leads to difficulty in epidemiologic and economic analysis and ethical issues of informed consent and health equity. The findings of this review may be used by the stakeholders of MT, including patients and providers, to enhance informed decision-making and quality of care.
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Affiliation(s)
- Brittany M Foley
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ 85054, Kingston, RI 02881, USA
| | - Jack M Haglin
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ 85054, Kingston, RI 02881, USA
| | | | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Martinez AE, Gass SK, Meylan S, Franzeck F, Tschudin-Sutter S, Tremp M, Schaefer DJ, Barandun M, Bättig V. [Breast pain and fever in a 46-year-old immunosuppressed patient with breast implants]. Internist (Berl) 2019; 60:1102-1105. [PMID: 31451847 DOI: 10.1007/s00108-019-00665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 46-year-old immunosuppressed patient presented with a breast implant-associated infection 10 years after breast augmentation in Southeast Asia. No pathogen was identified in the initial conventional microbiological workup. Subsequently, infection with Mycobacterium abscessus-a nontuberculous mycobacteria-was diagnosed using a special culture technique. Increased rates of such infections are reported after cosmetic surgery in foreign countries, presumably due to inoculation with these ubiquitous pathogens. This case highlights the fact that the differential diagnosis and thus the microbiological workup should be extended in cases without initial pathogen detection.
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Affiliation(s)
- A E Martinez
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - S K Gass
- Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Basel, Schweiz
| | - S Meylan
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - F Franzeck
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - S Tschudin-Sutter
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - M Tremp
- Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Basel, Schweiz
| | - D J Schaefer
- Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Basel, Schweiz
| | - M Barandun
- Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Basel, Schweiz
| | - V Bättig
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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29
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Parel-Amini L, Uçkay I, Rüegg E, Homsy A, Pittet-Cuénod B, Modarressi A. Les enjeux du tourisme chirurgical dans le domaine de la chirurgie esthétique. ANN CHIR PLAST ESTH 2019; 64:293-297. [DOI: 10.1016/j.anplas.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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30
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The what, when and how in performing and interpreting microbiological diagnostic tests in skin and soft tissue infections. Curr Opin Infect Dis 2019; 31:104-112. [PMID: 29337704 DOI: 10.1097/qco.0000000000000433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To summarize and classify the most recent and relevant microbiological studies for each type of skin and soft tissue infection (SSTI). RECENT FINDINGS Following Infectious Diseases Society of America and Food and Drug Administration classifications of SSTIs, we differentiate between two large groups, the superficial or uncomplicated infections and the complicated infections with deep involvement. It is not usually necessary to obtain microbiological samples in uncomplicated infections, except in cases of recurrences or for epidemiological control purposes. In the case of complicated infections, the samples are of two different types: those obtained from the affected area (surgical samples, punctures of abscesses or swabs) and systemic samples (i.e. blood cultures). The clinical condition also determines the type of samples to be obtained. In cases of systemic involvement, blood cultures are mandatory. For immunocompromised patients, who may present atypical infections, detection of antigens, serologies or molecular biology techniques may be helpful. The rapid diagnosis is currently the goal to be pursued by implementing techniques such as matrix assisted laser desorption ionization-time of flight, commercial real-time PCR or the promising metagenomics. SUMMARY Microbiological diagnosis is one of the cornerstones of the management of SSTIs. Prompt obtaining and processing of the necessary samples, depending on the clinical situation of the patient, is of relevance in the decision-making process. Rapid and fluid reporting of the results (identification, mechanisms of resistance and antibiogram) will improve the management of these patients.
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Lee RA, Wigmore R. A Case of Lipotourism-associated Multidrug-resistant Mycobacterium abscessus Infection. J Glob Infect Dis 2019; 11:83-85. [PMID: 31198313 PMCID: PMC6555235 DOI: 10.4103/jgid.jgid_148_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rapidly growing mycobacteria have become increasingly recognized as pathogens implicated in surgical site infections that can be both difficult to diagnose and treat with an evolving understanding of both intrinsic and acquired resistance patterns. As common environmental commensal organisms that can colonize water supplies, they are of particular concern in the setting of a growing medical tourism industry. We present a case of a 49-year-old woman who acquired a highly multidrug-resistant Mycobacterium abscessus skin and soft-tissue infection after cosmetic abdominoplasty that required radical surgical debridement and 6 months of intravenous therapy to eradicate. This case highlights the challenges in the management of M. abscessus infections including delay to diagnosis and resistance patterns that are likely to become more common despite antibiotic stewardship efforts.
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Affiliation(s)
- Rose Anne Lee
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, US
| | - Robin Wigmore
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, US
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Dowdell K, Haig SJ, Caverly LJ, Shen Y, LiPuma JJ, Raskin L. Nontuberculous mycobacteria in drinking water systems - the challenges of characterization and risk mitigation. Curr Opin Biotechnol 2019; 57:127-136. [PMID: 31003169 DOI: 10.1016/j.copbio.2019.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/18/2022]
Abstract
Nontuberculous mycobacteria (NTM) pulmonary infections are a growing concern worldwide, with a disproportionate incidence in persons with pre-existing health conditions. NTM have frequently been found in municipally-treated drinking water and building plumbing, leading to the hypothesis that an important source of NTM exposure is drinking water. The identification and quantification of NTM in environmental samples are complicated by genetic variability among NTM species, making it challenging to determine if clinically relevant NTM are present. Additionally, their unique cellular features and lifestyles make NTM and their nucleic acids difficult to recover. This review highlights a recent work focused on quantification and characterization of NTM and on understanding the influence of source water, treatment plants, distribution systems, and building plumbing on the abundance of NTM in drinking water.
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Affiliation(s)
- Katherine Dowdell
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Sarah-Jane Haig
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lindsay J Caverly
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Yun Shen
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - John J LiPuma
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Lutgarde Raskin
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA.
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Affiliation(s)
| | | | - David L Goldman
- Department of Pediatrics and Microbiology and Immunology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
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Medical Tourism and Postoperative Infections: A Systematic Literature Review of Causative Organisms and Empiric Treatment. Plast Reconstr Surg 2019; 142:1644-1651. [PMID: 30489537 DOI: 10.1097/prs.0000000000005014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medical tourism has become increasingly globalized as individuals travel abroad to receive medical care. Cosmetic patients in particular are more likely to seek surgery abroad to defray costs. Unfortunately, not all procedures performed abroad adhere to strict hygienic regulations, and bacterial flora vary. As a result, it is not uncommon for consumers to return home with difficult-to-treat postoperative infections. METHODS A systematic literature review of PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was performed to assess the microbiology patterns and medical management of patients with postoperative infections after undergoing elective surgery abroad. RESULTS Forty-two cases of postoperative infections were reported among patients who underwent elective surgery abroad. Most cases were reported from the Dominican Republic, and the most common elective procedures were abdominoplasty, mastopexy, and liposuction. Rapidly growing mycobacteria such as Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae were among the most common causes of postoperative infection, with M. abscessus involving 74 percent of cases. Most cases were treated with surgical débridement and a combination of antibiotics. Clarithromycin, amikacin, and moxifloxacin were the most common drugs used for long-term treatment. CONCLUSIONS When encountering a patient with a history of medical tourism and treatment-refractory infection, rapidly growing mycobacteria must be considered. To increase the likelihood of yielding a diagnostic organism, multiple acid-fast bacilli cultures from fluid and débridement content should be performed. There has been reported success in treating rapidly growing mycobacterial infections with a combination of antibiotics including clarithromycin, amikacin, and moxifloxacin.
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Crist MB, Perz JF. Modern Healthcare Versus Nontuberculous Mycobacteria: Who Will Have the Upper Hand? Clin Infect Dis 2018; 64:912-913. [PMID: 28082270 DOI: 10.1093/cid/ciw881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Matthew B Crist
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph F Perz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
The increasing popularity of medical tourism among US citizens has led to the rising incidence of nontuberculous mycobacteria (NTM) infections from cosmetic surgery performed in other countries. Clinicians must be aware of these infections and the potential difficulties in treating them. The most common NTM species isolated from cutaneous infections in medical tourists is Mycobacterium abscessus. Because many NTM species are antibiotic resistant, combination therapy is needed to combat skin and soft-tissue NTM infections in patients who had cosmetic procedures performed in foreign countries.
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37
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All in The Name of Vanity. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ryan K, Byrd TF. Mycobacterium abscessus: Shapeshifter of the Mycobacterial World. Front Microbiol 2018; 9:2642. [PMID: 30443245 PMCID: PMC6221961 DOI: 10.3389/fmicb.2018.02642] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/16/2018] [Indexed: 01/23/2023] Open
Abstract
In this review we will focus on unique aspects of Mycobacterium abscessus (MABS) which we feel earn it the designation of "shapeshifter of the mycobacterial world." We will review its emergence as a distinct species, the recognition and description of MABS subspecies which are only now being clearly defined in terms of pathogenicity, its ability to exist in different forms favoring a saprophytic lifestyle or one more suitable to invasion of mammalian hosts, as well as current challenges in terms of antimicrobial therapy and future directions for research. One can see in the various phases of MABS, a species transitioning from a free living saprophyte to a host-adapted pathogen.
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Affiliation(s)
- Keenan Ryan
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM, United States
| | - Thomas F. Byrd
- Department of Medicine, The University of New Mexico School of Medicine, Albuquerque, NM, United States
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39
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Mycobacterium abscessus Complex Cutaneous Infection. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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40
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Summers NA, Kempker R, Palacio F. Mycobacterium abscessus subspecies massiliense infection after skin graft and cholecystectomy in a burn patient. Int J Infect Dis 2018; 76:29-31. [PMID: 30170154 PMCID: PMC6248876 DOI: 10.1016/j.ijid.2018.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022] Open
Abstract
Diagnosing skin and soft tissue infections due to rapidly growing mycobacteria (RGM) can often prove difficult, leading to delays in treatment. Postoperative infections caused by RGM are increasingly recognized both within and outside the USA, but are rarely encountered in burn units. We report a case of postoperative skin and soft tissue infection along a cholecystectomy incision in a burn patient caused by Mycobacterium abscessus subsp. massiliense. Postoperative infections caused by RGM require a high index of suspicion, often necessitating biopsy for definitive diagnosis. Physicians should consider this diagnosis when postoperative infections arise later than typically seen for routine bacterial infections and fail to respond to first-line therapy.
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Affiliation(s)
- Nathan A Summers
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Russell Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Federico Palacio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Pereira RT, Malone CM, Flaherty GT. Aesthetic journeys: a review of cosmetic surgery tourism. J Travel Med 2018; 25:5039932. [PMID: 29924349 DOI: 10.1093/jtm/tay042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/23/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism. METHODS Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'. RESULTS This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed. CONCLUSION This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.
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Affiliation(s)
| | - Carmel M Malone
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Henkle E, Hedberg K, Schafer SD, Winthrop KL. Surveillance of Extrapulmonary Nontuberculous Mycobacteria Infections, Oregon, USA, 2007-2012. Emerg Infect Dis 2018; 23:1627-1630. [PMID: 28930014 PMCID: PMC5621539 DOI: 10.3201/eid2310.170845] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Limited data are available describing extrapulmonary nontuberculous mycobacteria (NTM) infections in the general population. We describe results from statewide population-based laboratory surveillance in Oregon, USA, during 2007–2012. We defined a case of extrapulmonary NTM infection as >1 isolate from skin/soft tissue, disseminated sites, lymph node, joint, or other sites. The annual incidence of extrapulmonary NTM infection (other than Mycobacterium gordonae) was stable, averaging 1.5 cases/100,000 population. Median age of the 334 patients was 51 years, and 53% of patients were female. Half of cases were caused by M. avium complex, but rapid-growing NTM species accounted for one third of cases. Most extrapulmonary NTM infections are skin/soft tissue. Compared with pulmonary NTM infection, more extrapulmonary infections are caused by rapid-growing NTM species. the designation of NTM as a reportable disease in Oregon in 2014 will result in better detection of changes in the incidence and patterns of disease in the future.
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43
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Desai AN, Hurtado RM. Infections and outbreaks of nontuberculous mycobacteria in hospital settings. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018; 10:169-181. [PMID: 30662371 DOI: 10.1007/s40506-018-0165-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose of review Non-tuberculous mycobacterial [NTM] infections in the hospital setting are a complex and often challenging entity. The goal of this review is to discuss diagnostic and treatment strategies for established as well as emerging nosocomial NTM infections. Recent findings NTM outbreaks have been documented in a variety of hospital settings. Contamination of medical devices or aqueous solutions is often implicated in the spread of infection. More recently, the slow grower M. chimaera has been reported in the setting of contaminated heater-cooler devices used for cardiopulmonary bypass and extracorporeal membrane oxygenation. In addition, increases in medical tourism for cosmetic surgery have led to outbreaks of rapidly growing mycobacteria. Summary Diagnosis and treatment of nosocomial NTM pose many challenges for the clinician. Surgical resection or debridement as well as combination antimycobacterial therapy are a mainstay in therapeutic management. Strict infection control and prevention practices are critical to the identification and cessation of outbreaks.
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Affiliation(s)
- Angel N Desai
- Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Boston, MA 02114 USA
| | - Rocío M Hurtado
- Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Boston, MA 02114 USA.,Harvard Medical School, 25 Shattuck St, Boston MA 02115 USA
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Gaines J, Poy J, Musser KA, Benowitz I, Leung V, Carothers B, Kauerauf J, Mollon N, Duwell M, Henschel K, De Jesus A, Head SK, Lee K, Arboleda N, Esposito DH. Notes from the Field: Nontuberculous Mycobacteria Infections in U.S. Medical Tourists Associated with Plastic Surgery - Dominican Republic, 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:369-370. [PMID: 29600972 PMCID: PMC5877360 DOI: 10.15585/mmwr.mm6712a5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the emerging literature on nontuberculous mycobacteria outbreaks in healthcare settings. As our ability to identify mycobacterial species develops, we are better able to recognize epidemiologic connections and better understand the prevalence and importance of these outbreaks and pseudo-outbreaks in healthcare settings. RECENT FINDINGS The number of outbreaks related to nontuberculous outbreaks is increasing because of heightened awareness and better diagnostic tests for species level identification of mycobacteria. Outbreaks in healthcare settings have been related to cardiac surgery, plastic surgery, including medical tourism, colonized humidifiers and heater-cooler devices, imperfect disinfection, and hospital water sources. Mycobacteria have a predilection to form biofilms, are resistant to disinfection and are prevalent in hospital water systems. Patients with structural lung disease like cystic fibrosis patients are at particularly high risk for mycobacterial infection. It has been thought that acquisition in this patient population is from common environmental exposure; however, there is increasing evidence that transmission in this patient population can occur through either direct or indirect patient-to-patient spread. SUMMARY Mycobacteria outbreaks in healthcare settings have been underrecognized. As we identify additional clusters of infection with better diagnostic tools and heightened awareness, we will likely need better infection control practices to prevent infections in healthcare settings.
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Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTIs) are the most frequent infectious cause of referrals to emergency departments and hospital admissions in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology and management of SSTIs. RECENT FINDINGS Incidence trends of SSTIs were increasing worldwide with Staphylococcus aureus and streptococci predominating and methicillin-resistant S. aureus (MRSA) posing additional challenges, because of high rates of treatment failure and relapse. Development of new antimicrobials was associated with an appraisal of regulatory definitions and endpoints. Prediction of clinical response can be very tricky, because of variable risk factors for recurrence or treatment failure, depending mostly on the host. Precise indications for new antimicrobials should be established; their integration into clinical practice algorithms may serve reduction of unnecessary admissions, overtreatment and total costs. SUMMARY New antimicrobials with activity against MRSA have been recently launched. Long-acting agents, mainly oritavancin and dalbavancin, provide the opportunity of single-dose treatment and early discharge. Further outpatient treatment options include new per os antibiotics such as oxazolidinones. Validated assessment tools are urgently needed to support decision-making toward rational resource utilization and delivery of optimal treatment.
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48
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Sabin AP, Ferrieri P, Kline S. Mycobacterium abscessus Complex Infections in Children: A Review. Curr Infect Dis Rep 2017; 19:46. [PMID: 28983867 PMCID: PMC5821427 DOI: 10.1007/s11908-017-0597-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Infections in children with Mycobacterium abscessus complex represent a particular challenge for clinicians. Increasing incidence of these infections worldwide has necessitated focused attention to improve both diagnostic as well as treatment modalities. Published medical literature was reviewed, with emphasis on material published in the past 5 years. RECENT FINDINGS Increasing availability of new diagnostic tools, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry and custom PCRs, has provided unique insights into the subspecies within the complex and improved diagnostic certainty. Microbiological review of all recent isolates at the University of Minnesota Medical Center was also conducted, with description of the antimicrobial sensitivity patterns encountered in our center, and compared with those published from other centers in the recent literature. A discussion of conventional antimicrobial treatment regimens, alongside detailed description of the relevant antimicrobials, is derived from recent publications. Antimicrobial therapy, combined with surgical intervention in some cases, remains the mainstay of pediatric care. Ongoing questions remain regarding the transmission mechanics, immunologic vulnerabilities exploited by these organisms in the host, and the optimal antimicrobial regimens necessary to enable a reliable cure. Updated treatment guidelines based on focused clinical studies in children and accounting especially for the immunocompromised children at greatest risk are very much needed.
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Affiliation(s)
- Arick P Sabin
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC # 250, Minneapolis, MN, 55455, USA
| | - Patricia Ferrieri
- Department of Laboratory Medicine and Pathology and Department of Pediatrics, Division of Infectious Diseases, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Susan Kline
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC # 250, Minneapolis, MN, 55455, USA.
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Mehta A, Goldstein SD, Makary MA. Global trends in center accreditation by the Joint Commission International: growing patient implications for international medical and surgical care. J Travel Med 2017; 24:4090960. [PMID: 28931151 DOI: 10.1093/jtm/tax048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention.
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Affiliation(s)
- Ambar Mehta
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Seth D Goldstein
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Barie PS. Atypical Wound Pathogens. Surg Infect (Larchmt) 2017; 18:455-460. [PMID: 28541806 DOI: 10.1089/sur.2017.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atypical wound pathogens may be so described because they are uncommon pathogens of soft tissue among human beings, or because they may be fastidious and difficult to recover/isolate in the laboratory. METHODS A review of pertinent English-language literature was performed. RESULTS These wound pathogens are a diverse lot, including aerobic and anaerobic gram-positive and gram-negative bacilli, non-tuberculous mycobacteria, and bacteria that cannot be characterized conventionally because they lack a cell wall (the Mycoplasmataceae). They are diverse with respect to their virulence, but many are opportunistic pathogens. CONCLUSIONS Among these atypical pathogens, clinical reports are most common of wound infections caused by Mycoplasma/Ureaplasma (sometimes as co-infecting agents), and the so-called rapidly growing non-tuberculous mycobacteria (Runyon Type IV; e.g., M. chelonae).
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Affiliation(s)
- Philip S Barie
- Departments of Surgery and Medicine, Weill Cornell Medicine , New York, New York
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