Epidemiological study of an outbreak of non-tuberculous Mycobacteria subcutaneous infections after mesotherapy
Abstract number: O314
Carbonne A., Arnaud I., Brossier F., Bougmiza I., Cambau E., Meningaud J., Jarlier V., Caumes E., Astagneau P.
Objectives: Mesotherapy is an increasing used technique involving subcutaneous injections of minute quantity of various medical drugs for cosmetic or rheumatism purposes. This practice was already reported to be related to infection risk.
In January 2007, a general practitioner notified to the health authorities and the regional centre for infection control a cluster of subcutaneous infections due to non-tuberculosis Mycobacteria (NTM) following mesotherapy. An epidemiological investigation was performed to describe the outbreak, to identify the source and the mechanism of contamination and to determine risk factors.
Methods: The case definition was based on typical clinical subcutaneous lesion associated with positive specimens for NTM. An assessment practice study was performed to determine potential risk factors to be tested in a comparative epidemiological study. Data were collected including schedules of outpatient visits, localisation of injections, and type of injected products. Tap water of the medical examination room was sampled for search of Mycobacteria. Mycobacterium chelonae strains were compared using Pulsed Field Gel Electrophoresis (PFGE).
Results: Overall, 16 cases were identified among 105 outpatients (attack rate: 15.2%), including 11 positive for Mycobacterium chelonae and 2 for M. frederiksbergense. M. chelonae was found in the tap water. Assessment practice study identified inappropriate cleaning and rinsing of the multiple injection device (automatic repetitive machine) using tap water which was likely to be the source of NTM contamination. Indeed, PFGE M. chelonae strains patterns were similar between patients and tap water samples. The multivariate logistic regression analysis showed that to be at the second rank during a mesotherapy session (Odds ratio = 4.15 [1.213.9]) and to have more days of mesotherapy cares delivered after room closure (Odds ratio = 1.03 [1.011.05]) were independent risk factors of NTM infection.
Conclusion: This outbreak investigation highlights that failure in disinfection of injecting material could generate severe infections with highly resistant bacteria related to non regular medical cares. Efforts should focus on control of hygiene practices in non hospital settings based on appropriate guideline recommendations.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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