Risk Factors for Mycobacterium abscessus subsp. bolletii infection after laparoscopic surgery during an outbreak in Brazil

OBJECTIVETo identify risk factors related toMycobacterium abscessussubsp.bolletiiinfection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases.DESIGNA retrospective cohort study.SETTINGA private hospital in Manaus, Brazil.PATIENTSA cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team.METHODSWe collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables withP≤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.RESULTSWe 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.CONCLUSIONSBecause 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