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BACKGROUND: Mycobacterium fortuitum is a ubiquitous environmental bacterium increasingly associated with surgical-site infections (SSIs), causing disfiguring infections that require prolonged antibiotic regimens. In October 2011, an outbreak of five M. fortuitumSSIs was reported among patients at a Los Angeles County ambulatory plastic surgery center (Facility A). We investigated to identify the source and stop transmission.
METHODS: Cases were SSIs presenting >30 days after surgery at Facility A during December 2010–October 2012. A case-control study was conducted; control subjects were well patients selected randomly from months without cases. Pulsed-field gel electrophoresis (PFGE) was performed on available M. fortuitumisolates. Site visits were conducted for chart review, observation of infection control practices, and environmental sampling.
RESULTS: Seven cases were identified, including a second cluster that underwent surgery during June–July 2012. Case-patients and control subjects did not differ by surgical staff, patient order, day of week, or surgery length. PFGE of isolates from case-patients undergoing surgery over a 14-month period in this outbreak was indistinguishable, suggesting a common source. Infection control breaches were observed, including medication vials opened with a nonsterile tool for wound irrigation and a microwave shared for sterile solutions and food. Approximately 100 specimens were collected, including water from multiple sources. All were M. fortuitumculture–negative, except for a sample from an upstairs aquarium that had previously leaked into Facility A’s ceiling; PFGE of this isolate is pending.
CONCLUSIONS: Strict adherence to aseptic technique, including sterile access of medication vials intended for wound irrigation and dedication of equipment for surgical use, might have prevented this outbreak. Oversight of infection control practices in ambulatory surgical centers, which differs widely, may prevent outbreaks.