Sunday, September 17, 2006

Tracking outbreaks of unusual breast augmentation infections

An interesting study of microbial forensics was published about surgical wound infections caused by an unusual and rapidly growing mycobacterium (seen at right) developed in 15 women after breast augmentation. Using sophisticated DNA sequencing, the outbreak was traced back to a single surgeon operating at an outpatient surgery center.

Identical strains of mycobacterium were grown from the infected wounds of the patients; from the eyebrows, hair, face, nose, ears, and groin of this particular surgeon. What's also interesting was the infection was also thriving in the surgeon's outdoor whirlpool. As this strain of mycobacterium was somewhat distinct from common strains, the authors have proposed "Mycobacterium jacuzzii", which I think that's some kind of inside nerd joke :)

When "Typhoid Hairy" discontinued his use of the whirlpool and began cleaning the hairy areas of his body with a shampoo containing triclosan, the outbreak ended.

Clinical infections with breast implant surgery are very low, usually cited as <1%. Routine procedure would include an antimicrobial skin prep as well as a dose of antibiotics prior to surgery. Subclinical bacterial contamination has been suspected (though not proved) to be the cause of many cases of capsular contracture (hardening of the breast)as it seems that irrigation of the pocket around the implant with triple antibiotic solutions seem to be effective in reducing (but not eliminating) capsular contracture.

Physician to patient infections can occur in many scenarios. Hand washing and gowns in particular have received a lot of attention in recent years. A number of outbreaks have been traced to one person. Often this has been MRSA which can asymptomatically colonize people, most commonly harboring quietly in their nasal passage. Just this week I diagnosed and started treatment on a nurse who was having outbreaks of MRSA boils break out on her frequently. One of the most heart-breaking stories has been the outbreak of infections in neonatal ICU's & nurseries attributed to infections harbored under nurses fingernails.

From an article on Sign on San Diego discussing this:
Studies offer mounting evidence that long nails or those that are bonded with cosmetic acrylic or plastic material can shelter bacteria, viruses or fungi such as yeast and pose a special danger to those with weakened immune systems. According to a growing number of studies, nails longer than a quarter of an inch offer a good environment for infections to grow. Newborns, patients with cancer and other diseases, and those in high-risk settings such as intensive-care units or operating rooms are especially vulnerable.


1 comment:

Anonymous said...

Not much sleuthing required when they were all patients of the same doc...

I like the "jaccuzii" proposal.

Interesting, the possible relation of capsular contracture to sub-clinical infection.

Finally: I always thought you plastic guys spent too much time in hot-tubs.