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CDC call for cases of NTM following cosmetic surgery in the Dominican Republic

Purpose of document: This is a call for cases issued by the Centers for Disease Control and Prevention.

Brief Summary of Report: Several state and local health departments are investigating recent cases of nontuberculous mycobacteria surgical site infections (e.g., Mycobacterium abscessus, Mycobacterium massiliense) associated with cosmetic surgery received in the Dominican Republic.

Description: Since 1 January 2017, multiple states have identified cases of nontuberculous mycobacteria (NTM) surgical site infections in patients after returning from a trip to the Dominican Republic for cosmetic surgery. The majority of the isolates have been identified as Mycobacterium abscessus and were associated with the Centro Internacional de Cirugia Plastica Avanzada (CIPLA), Santa Domingo, Dominican Republic. Other U.S. residents who have undergone cosmetic surgery procedures in the Dominican Republic may be at risk for similar infections. Please report any similar cases to your state or local health department.

Information for healthcare providers

  • Clinicians should consider nontuberculous mycobacteria (NTM) infections in the differential diagnosis for all people who have wound infections after surgery abroad, including surgery that has occurred weeks to months previously.
  • Consider NTM infection in patients who have surgical site infections unresponsive to standard treatment.
  • NTM are commonly antimicrobial drug resistant and difficult to treat. These infections may require protracted and complex antibacterial drug combinations and courses, which may benefit from consultation with an infectious disease specialist. Surgical interventions are frequently necessary adjuncts to antibacterial drug therapy.
  • Although NTM grow well on routine bacterial culture media, clinical specimens frequently fail to exhibit growth after empiric use of common antibacterial drug therapy, particularly when swab specimens are collected instead of body fluids or tissue. Some patients with these infections may have acid fast–positive smears or tissue preparation but no organism recovered on culture.
  • To minimize diagnostic delays, especially when encountering surgical site infections among medical tourists, clinicians should consider NTM infection, collect adequate specimens, and communicate this suspicion to ensure correct laboratory testing is performed.

For more information, visit https://wwwnc.cdc.gov/travel/notices/alert/medical-tourism-dominican-republic

Report Category: Infectious Disease: bacterial, health care related infections, travel-related infections, tuberculosis and other mycobacterial

 

 

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