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Risk Factors for Mycobacterium abscessus subsp. bolletii Infection After Laparoscopic Surgery During an Outbreak in Brazil

Published online by Cambridge University Press:  05 January 2015

Gabriela Baruque Villar ,
Felipe Teixeira de Mello Freitas ,
Jesus Pais Ramos ,
Carlos Eduardo Dias Campos ,
Paulo Cesar de Souza Caldas ,
Fernanda Santos Bordalo ,
Tatyana Costa Amorim Ramos ,
Vívian do Nascimento Pereira ,
Marcelo Cordeiro-Santos  and
Joao Hugo Abdalla Santos
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Gabriela Baruque Villar*
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
Felipe Teixeira de Mello Freitas
Affiliation:
Núcleo de Medicina Tropical, Universidade de Brasília, Brasilia, Distrito Federal, Brazil
Jesus Pais Ramos
Affiliation:
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
Carlos Eduardo Dias Campos
Affiliation:
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
Paulo Cesar de Souza Caldas
Affiliation:
Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
Fernanda Santos Bordalo
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
Tatyana Costa Amorim Ramos
Affiliation:
Comissão Estadual de Controle de Infecção hospitalar, Fundação de Vigilância em Saúde, Manaus, Amazonas, Brazil
Vívian do Nascimento Pereira
Affiliation:
Comissão Estadual de Controle de Infecção hospitalar, Fundação de Vigilância em Saúde, Manaus, Amazonas, Brazil
Marcelo Cordeiro-Santos
Affiliation:
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
Joao Hugo Abdalla Santos
Affiliation:
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
Glauco Coelho Motta
Affiliation:
Laboratório Central de Saúde Pública do Amazonas, Fundação de Vigilância em Saúde, Manaus, Amazonas, Brazil
Suzie Marie Gomes
Affiliation:
Brazillian Sanitary Agency (Agência Nacional de Vigilância Sanitária), Brasilia, Distrito Federal, Brazil
Verena Maria Mendes de Souza
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
Wildo Navegantes de Araujo
Affiliation:
Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde – EPISUS – 2010-2012 (Field Epidemiology Training Program – FETP), Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, Distrito Federal, Brazil Universidade de Brasília - Campus Ceilândia, Brasilia, Distrito Federal, Brazil
*
Address correspondence to Gabriela B. Villar, MD, MSc, Esplanada dos Ministérios Bloco G, Ministério da Saúde, Ed. Sede, 1st floor, room 137, Brasília, Distrito Federal, Brazil (villargb@gmail.com).
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Abstract

OBJECTIVE

To identify risk factors related to Mycobacterium abscessus subsp. bolletii infection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases.

DESIGN

A retrospective cohort study.

SETTING

A private hospital in Manaus, Brazil.

PATIENTS

A cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team.

METHODS

We collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables with P≤0.2 in the bivariate analysis in a logistic regression model. Additionally, we reviewed the procedures for reprocessing the laparoscopic surgery equipment, and the strains obtained with culture were identified by molecular methods.

RESULTS

We recorded 60 (27%) cases of infection. After multivariate analysis, the duration of surgery beyond 1 hour (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2–4.5), not to have been the first operated patient on a given day (OR, 2.7; 95% CI, 1.4–5.2), and the use of permanent trocar (OR, 2.2; 95% CI, 1.1–4.2) were associated with infection. We observed that the surgical team attempted to sterilize the equipment in glutaraldehyde solution when sanitary authorities had already prohibited it. Eleven strains presented 100% DNA identity with a single strain, known as BRA100 clone.

CONCLUSIONS

Because contaminated material can act as vehicle for infection, ensuring adequate sterilization processing of video-assisted surgery equipment was crucial to stopping this single clonal outbreak of nonturbeculous mycobacteria in Brazil.

Infect Control Hosp Epidemiol 2015;36(1): 81–86

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 81 - 86
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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