The Division of Global Migration and Quarantine and the Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control (CDC) are investigating cases of surgical-site infections caused by rapidly growing Mycobacterial species (e.g. M. abscessus and M. chelonae) following plastic surgery in the Dominican Republic.
Fifteen cases – all resulting from procedures performed in the Dominican Republic – have been identified in five states, prompting several state and local health departments in the northeast United States to issue an advisory for health-care providers to be aware of the condition, and to notify their local health department in the event they should identify or suspect a case. “Though the cases so far appear to have been identified only in the northeast, it’s important for all ASPS members to be alert to the potential of this infection,” says ASPS President Robert X. Murphy Jr., MD. “Ease of travel has turned medical tourism into a booming industry. Unfortunately, people often don’t think of the downside of medical tourism – you’re not guaranteed the same quality of safety measures that exist in this country, and should you have problems after you return, your surgeon is not there to take care of you.”
The advisory is aimed at all plastic surgery; dermatology; primary care; family, emergency and internal medicine; general surgery; infectious disease; laboratory medicine (including Mycobacteriology laboratory and staff) and infection control staff. The American Society of Plastic Surgeons is now collaborating with the CDC, in order to effectively disseminate this information to the ASPS membership. “These surgical-site infections represent a serious public health problem affecting patients who opt for low-cost cosmetic plastic surgery procedures overseas, in this case, the Dominican Republic,” says ASPS Patient Safety Committee Chair C. Bob Basu, MD, MPH. “Medical tourism may attract patients with ‘cheap deals,’ but unfortunately, these deals may compromise, or worse, completely ignore recognized quality and safety standards. “It underscores why it is vital for patients to choose a board-certified plastic surgeon who is an ASPS member,” he adds. “Our members only perform procedures in fully accredited facilities that ensure the highest standards for infection control and patient safety.“
Initial cases were reported by the Maryland Department of Health and Mental Hygiene in August 2013, with additional cases identified since then in Connecticut, Massachusetts, New York and Pennsylvania. All patients were women in the 18-50 age range who had undergone elective procedures that include abdominoplasty, mammaplasty and liposuction in the Dominican Republic from April through September in 2013. Symptoms have included abdominal abscess, pain, fever and wound discharge. No deaths have occurred. “At least nine of the case-patients had surgery at the same surgical center and were attended by the same surgeon,” notes Duc Nguyen of the CDC’s Prevention and Response branch of the DHQP, via e-mail. “Symptoms of infection developed after return to the United States; several patients consulted with plastic surgeons
after their return who, in turn, notified their state and local health departments.” “Given that at least nine of the cases are arising from the same surgery center in the Dominican Republic,” adds Dr. Basu, “it raises deep concerns about the violation of sterilization procedures and the quality of the sterile products utilized.”
Others who may have undergone surgical procedures in the Dominican Republic may be at risk for the “rapidly growing non-tuberculous mycobacterium” (RG-NTM) infections. “It is possible that additional infected patients have not yet been reported,” notes Nguyen. Healthcare providers should be aware of these cases and obtain cultures for mycobacterial culture from patients with cellulitis, soft tissue infection or cutaneous abscess who had a surgical procedure in the Dominican Republic after April 1, 2013. Physicians should notify their local health department if a case is identified.