Mycobacterium chelonaeWound Infections after Plastic Surgery Employing Contaminated Gentian Violet Skin-Marking Solution

Abstract

From April 1 to October 31, 1985, postoperative surgical-wound infections due to rapidly growing mycobacteria developed in eight patients undergoing cosmetic plastic surgery performed by one surgeon. All infections followed either face-lift or augmentation-mammoplasty procedures performed in the surgeon's office; no infections occurred after surgical procedures performed at the hospital or after other surgical procedures performed at the office. An epidemiologic investigation implicated a gentian violet skin-marking solution as the source of the infections (P less than 0.001). Among patients exposed to the gentian violet, infection was significantly more likely to develop in those undergoing a face lift or augmentation mammoplasty than in those undergoing blepharoplasty (P less than 0.001). Additional risk factors for infection included the postoperative use of antibiotics and glucocorticoids. Mycobacterium chelonae, subspecies abscessus, was isolated from the gentian violet stock used by the surgeon and from five of the eight patients. Additional studies showed that the same organism was present in the gentian violet stock at the pharmacy that supplied the agent to the surgeon. After a sterile skin-marking agent was substituted for the contaminated agent, no further cases occurred.

Iatrogenic outbreak of M. chelonae skin abscesses

“…(15), open heart and cardiac surgery [16,19,38], mammoplasty [17], dialysis [20][21][22] and in people who had undergone invasive procedures at a podiatry office [18]. In Colombia, since 1981, there have been reports of isolated cases with soft tissue lesions [14].…”

“…Other studies have established periods between 3 days and 2 years [15,17,18,20,24,25,41,42], but none of them followed Sartwell's methodology. Using data from one of the outbreaks [17], we could calculate a median incubation period of 34 days with a dispersion factor of 19, data very similar to ours.…”

“…Only a few authors have shown results about risk factors [17,18,21,24,25], but none of them found personal characteristics including gender, age, route or number of injections associated with mycobacterial disease.…”

“…chelonae has been aetiologically implicated in several clinical syndromes which include not only organ-specific pathology but also disseminated disease [6]. Isolated cases are common [7][8][9][10][11][12][13][14] but outbreaks are not [15][16][17][18][19][20][21][22].…”

“…These include vaccinations [15], injections with homesterilized needles, gunshot wounds, farm machinery accidents [5] and surgery [5,17,[23][24][25]. Use of nondisposable syringes or needles and multiple injections with the same needle, have also been found to be risk factors [10].…”