Breast Implant Infections and Jacuzzis
Breast Implant Infections and Jacuzzis
Abstract & Commentary
By Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, is Editor for Infectious Disease Alert.
Synopsis: An apparently novel, rapidly growing non-tuberculous mycobacterium, given the name Mycobacterium jacuzzii because of its recovery from hot tub water, was the cause of an outbreak of breast implant infections associated with a hot tub-suing surgeon whose skin was colonized with the organism.
Source: Rahav G, et al. An outbreak of Mycobacterium jacuzzii infection following insertion of breast implants. Clin Infect Dis. 2006;43:823-830.
From July through November 2003, a rapidly growing non-tuberculous Mycobacterium was recovered in culture from 11 of 15 women with wound infections after breast surgery — all but one involving silicon gel implants. Thirteen of the procedures were performed by a single surgeon; infection developed in 12 of 42 (28.6%) patients operated on by this individual. The same acid fast organism recovered from the patients was also recovered from this surgeon's eyebrows, scalp, face, nose, ears, and groin, as well as from his bed linen, pillows, towels, bathrobe, automobile air conditioning system, and from the water of his Jacuzzi. Colonization with the same organism was also detected on a family member who used the home whirlpool. The outbreak was aborted after the surgeon stopped using the whirlpool, washed daily with a triclosan containing preparation, and wore a hooded cap that covered all facial hair during surgery. No further cases occurred, and weekly cultures of the surgeon were negative for 2 years.
The mean interval from surgery to onset of clinical signs or symptoms of infection was 28 days (range, 16-39 days). All implants were removed, and most patients were treated with either ciprofloxacin and, in those with recurrence, with debridement together with ciprofloxacin and doxycycline. In vitro studies demonstrated that the isolates were resistant to clarithromycin, cefoxitin, imipenem, trimethoprim-sulfamethoxazole, rifampin, isoniazid, capreomycin, cycloserine, tobramycin, and streptomycin. They were susceptible to ciprofloxacin, ofloxacin, doxycycline, amikacin, and ethambutol.
Phenotypic analysis demonstrated resemblance of the isolated organism to Mycobacterium smegmatis and to Mycobacterium wolinskyi. Molecular analysis indicated, however, that it was a novel species for which the investigators suggest the name Mycobacterium jacuzzi.
Commentary
Organisms of the Mycobacterium avium complex are the cause of hot tub lung, which is apparently the result of a hypersensitivity reaction to aerosolized organisms. Many non-tuberculous mycobacteria find the warm waters a pleasing environment in which they happily exist in biofilm on the surfaces of pipes and other conduits. Planktonic organisms released from the biofilm readily come into contact with the skin of the hot tub user. While it appears they do not commonly cause cutaneous infection, the event described by Rahav and colleagues strongly suggests that they cause colonization of trichous portions of the skin from which they may be shed and serve as the cause of infection at a locus minoris resistentiae, such as the surgical wound of an exposed patient.
Infection with other rapidly growing mycobacteria (M. fortuitum, M. chelonae, M. abscessus) have previously been reported to caused breast implant infections.1 Experience with these infections, as with those described above, indicate that appropriate management involves removal of the implant and total excision of the surrounding capsule, as well as of all granulation tissue. Patients should receive antimicrobials to which their isolate is susceptible for a minimum of 6 weeks, with total duration dictated by clinical and laboratory assessment of the response of the infection.
Reference
- Vinh DC, Embil JM. Infection in breast implants. Lancet Infect Dis. 2005;5:462-463.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.