A cluster of nontuberculous mycobacteria (NTM) skin infections across nine states has been linked to cosmetic surgery procedures and gaps in infection control at a clinic in Florida, researchers with the Centers for Disease Control and Prevention (CDC) and the Florida Department of Health (FDOH) reported last week in Morbidity and Mortality Weekly Report.
After a non-Florida resident was identified with an NTM infection following a cosmetic procedure at a south Florida surgical clinic in February 2023, the CDC and FDOH issued a national Epidemic Information Exchange notice in March 2023 to identify additional cases. The subsequent investigation identified an additional 15 NTM infections in patients from nine states who underwent procedures at the same clinic (clinic A). An additional four patients experienced signs and symptoms of post-surgical infection but lacked confirmatory lab results.
The infections were caused by Mycbobacterium abscessus, a multidrug-resistant NTM known to cause skin and soft-tissue infections following cosmetic procedures. The 15 case-patients were all women in their early 30s whose symptoms began a median of 69 days after the procedure. Treatment required prolonged courses of oral and intravenous antibiotics.
Gaps in infection control
Clinic A was shut down, and although the source of the initial NTM infection was not identified, an infection control assessment at clinic B—which had the same surgeon, staff, and protocols as clinic A—by FDOH detected gaps in environmental cleaning practices, use of personal protective equipment, and surgical device disinfection.
"FDOH will use these findings to develop additional training for cosmetic surgery clinic staff members statewide to help prevent future outbreaks in this setting," the authors wrote, adding that healthcare providers should be on the lookout for extrapulmonary NTM when evaluating patients for postsurgical infection after cosmetic procedures.