Outbreak of Mycobacterium abscessus subspecies abscessus Associated with Cosmetic Surgeries in the Brazil/Paraguay Border Region: A Binational Investigation Between 2021 and 2022

Anti-microbial resistance
Healthcare Acquired or Nosocomial Infections

Background: In April 2022, Brazilian and Paraguayan International Health Regulation focal point (IHR) detected rumor about infections by rapid growing mycobacteria in aesthetic surgeries of one doctor in a hospital located in Pedro Juan Caballero, Paraguay. Thereafter, the countries started a collaborative investigation with their teams of field epidemiology training program to confirm the outbreak, control the transmission and analyze associated factors.

Methods: We conducted a retrospective cohort study with all aesthetic surgeries performed between August 2021 and April 2022 in the hospital, by involved doctor. Data were collected by telephone interview and review of medical records. Biopsies of surgical wounds were sent for etiologic agent identification and antimicrobial resistance testing. Relative risk was calculated as association measure, and ethical aspects were observed.

Results: 108 aesthetic surgeries - 85(78,7%) Brazilian and 23(21,3%) Paraguayan - were assessed in study period, with ten confirmed infections for Mycobacterium abscessus subsp. abscessus from same clone, causing an incidence of 9.2%. Extensively drug-resistance in all samples, full resistance to six antibiotics and intermediate resistance for two antibiotics were found. All infections occurred in healthy female (nine Brazilians and one Paraguayan); age range of 30-49 years old. The months with highest number of infected surgeries were December/2021 (4 of 21 – 19.0%) and January/2022(5 of 11 – 45.5%). People who have undergone surgery in January had more risk to became ill then others (RR: 6.5; 95%CI:2.3-18.5; p<0,001), and lipoabdominoplasty were associated to infection (RR:10.3; 95%CI:1.4-77.2; p<0,001). Control measures adopted were temporary suspension of surgeries and replacement of surgical equipment.

Conclusions: We confirmed an outbreak probably related to failures in the processing of surgical materials. The monitoring of rumors in health, the review by the IHR focal points and the joint work of both countries field epidemiology teams was key to containing the outbreak.