Furuya E Yoko, Paez Armando, Srinivasan Arjun, Cooksey Robert, Augenbraun Michael, Baron Miriam, Brudney Karen, Della-Latta Phyllis, Estivariz Concepcion, Fischer Staci, Flood Mary, Kellner Pamela, Roman Carmen, Yakrus Mitchell, Weiss Don, Granowitz Eric V
Department of Medicine, New York-Presbyterian Hospital-Columbia University Medical Center, New York, New York, USA.
Clin Infect Dis. 2008 Apr 15;46(8):1181-8. doi: 10.1086/529191.
Some US residents travel abroad to undergo cosmetic surgery for fat removal, a practice referred to as "lipotourism." Mycobacterium abscessus can cause postsurgical wound infection.
US residents who developed M. abscessus wound infection after undergoing cosmetic surgery in the Dominican Republic in 2003 and 2004 were identified using the Emerging Infections Network listserv.
Twenty returning US travelers with M. abscessus infection were detected. Eight patients had matching isolates, as determined by pulsed-field gel electrophoresis and repetitive element polymerase chain reaction. All 8 patients, who had previously been healthy Hispanic women, underwent abdominoplasties at the same clinic in the Dominican Republic. Symptoms first developed 2-18 weeks after the procedure (median interval, 7 weeks). Only 2 of the 8 patients received a correct diagnosis at the initial presentation. Most patients presented with painful, erythematous, draining subcutaneous abdominal nodules. Seven patients underwent drainage procedures. Six patients received a combination of antibiotics that included a macrolide plus cefoxitin, imipenem, amikacin, and/or linezolid; 2 received clarithromycin monotherapy. All patients but 1 were cured after a median of 9 months of therapy (range, 2-12 months). Because of a lack of access to the surgical clinic, the cause of the outbreak of infection was not identified. The patients who were infected with nonmatching isolates underwent surgeries in different facilities but otherwise had demographic characteristics and clinical presentations similar to those of the 8 patients infected with matching isolates.
This case series of M. abscessus infection in US "lipotourists" highlights the risks of traveling abroad for surgery and the potential role of the Internet in identifying and investigating outbreaks.
一些美国居民前往国外进行抽脂美容手术，这种做法被称为“抽脂旅游”。脓肿分枝杆菌可导致术后伤口感染。
通过新发感染网络邮件列表，确定2003年和2004年在多米尼加共和国接受美容手术后发生脓肿分枝杆菌伤口感染的美国居民。
检测到20名回国的美国旅行者感染了脓肿分枝杆菌。通过脉冲场凝胶电泳和重复元件聚合酶链反应确定，8名患者的分离株匹配。所有8名患者此前均为健康的西班牙裔女性，在多米尼加共和国的同一诊所接受了腹部整形手术。症状在手术后2至18周首次出现（中位间隔时间为7周）。8名患者中只有2名在初次就诊时得到了正确诊断。大多数患者表现为疼痛、红斑、有渗液的腹部皮下结节。7名患者接受了引流手术。6名患者接受了联合抗生素治疗，包括大环内酯类药物加头孢西丁、亚胺培南、阿米卡星和/或利奈唑胺；2名患者接受了克拉霉素单药治疗。除1名患者外，所有患者在中位9个月的治疗后（范围为2至12个月）均治愈。由于无法进入手术诊所，感染暴发的原因未查明。感染不匹配分离株的患者在不同机构接受了手术，但在人口统计学特征和临床表现方面与8名感染匹配分离株的患者相似。
该系列美国“抽脂游客”脓肿分枝杆菌感染病例突出了出国手术的风险以及互联网在识别和调查疫情中的潜在作用。
