We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
From the Centers for Disease Control and Prevention |

Rapidly Growing Mycobacterial Infection Following Liposuction and Liposculpture—Caracas, Venezuela, 1996-1998 FREE

JAMA. 1999;281(6):504-505. doi:10.1001/jama.281.6.504.
Text Size: A A A
Published online

MMWR. 1998;47:1065-1067

During October 1996-March 1998, nine patients in eight hospitals in Caracas, Venezuela, acquired surgical-site infections (SSI) caused by rapidly growing mycobacteria (RGM). All episodes of RGM infection occurred within 2 months after liposuction or liposculpture (aesthetic surgical procedures). This report describes the findings of an epidemiologic investigation of this cluster by the Venezuelan Ministry of Health and underscores the importance of sterilizing surgical equipment to prevent nosocomial infections.

A confirmed case was defined as RGM in a patient who underwent liposuction or liposculpture during October 1996-March 1998 (study period) in a surgical facility in Caracas, in whom local signs of SSI were present and for whom cultures of surgical site drainage grew RGM. A probable case was defined as RGM in a patient who underwent liposuction or liposculpture in a surgical facility in Caracas during the study period, who had local signs of infection at the surgical site, and for whom microscopic examination of stained smears of surgical site drainage were positive for acid-fast bacilli.

Seven confirmed and two probable cases from eight hospitals were identified. All case-patients were previously healthy women aged 28-49 years (median: 37.5 years). Eight surgeons and surgical teams performed the cosmetic surgery on the women. All nine case-patients underwent general anesthesia during their surgical procedure; procedures consisted of abdominal liposuction (seven patients), anterior and posterior thigh liposuction (three), or bilateral nasolabial fold liposculpture (two). The median time from surgical procedure to onset of infection was 15 days (range: 4-45 days). Clinical findings included fever, local inflammation, microabscesses, purulent drainage from the wound, or fistulae.

Seven case-patients had culture-confirmed RGM; species identified were Mycobacterium chelonae (four patients), M. fortuitum (two), and M. abscessus (one). Molecular typing of RGM isolates were not performed.

All hospitals cleaned surgical instruments (i.e., liposuction and liposculpture cannulae) with tap water and soap followed by low-level disinfection with a commercial quaternary ammonium solution. Environmental cultures, including cultures of tap water, at two surgical units did not yield bacteria or mycobacteria. The epidemiologic investigation did not reveal risk factors such as exposure to certain persons, cleaning solutions, medical supplies, or contaminated quaternary ammonium compounds.

Following the outbreak in Caracas, two of the affected surgical facilities modified their reprocessing procedures for surgical instruments (including suction cannulae) used in cosmetic surgical procedures by replacing quaternary ammonium compounds used for low-level disinfection with either high-level disinfection using 2% gluteraldehyde or ethylene oxide gas sterilization. No further cases of RGM infections complicating cosmetic surgical procedures in Caracas have been reported.


J Torres, J Murillo, L Bofill, A Ríos, E Irausquin, R Isturiz, M Guzmán, L Rubino, M Cordido, Venezuelan Collaborative Infectious Diseases and Tropical Medicine Study Group, Caracas; Ministry of Health, Venezuela. Hospital Infections Program, National Center for Infectious Diseases; and an EIS Officer, CDC.


This is the first official report to CDC of SSI caused by RGM following liposuction or liposculpture. Both surgical procedures involve small surgical wounds with limited environmental exposure; both require using cannulae for tissue suction. The underlying mechanism for the cluster of SSI described in this report was not determined. However, potential causes included contaminated tap water used in cleaning cannulae during liposuction or liposculpture or contamination of the quaternary ammonium solution used to disinfect these instruments.

Nosocomial infections associated with contaminated quaternary ammonium compounds that were used to disinfect patient-care supplies or equipment (e.g., cystoscopes, cardiac catheters, or surgical instruments) have been reported; none of these infections were caused by RGM. Quaternary ammonium compounds are used widely as low-level disinfectants.1 Surgical instruments used in liposuction and liposculpture procedures are critical items (i.e., intended to enter a normally sterile environment, sterile tissue, or the vasculature) according to the Spaulding Classification.2 Critical items should be sterilized between patient procedures.

Based on the risk for contamination of postsurgical wounds, aesthetic surgical procedures such as liposuction or liposculpture are considered clean wounds according to the classification system developed by the National Research Council.3 National Nosocomial Infections Surveillance (NNIS) system data indicate that among 5652 integumental surgical procedures (including aesthetic surgical procedures with risk index=0) performed during 1986-1996 in the United States, only 1.4% were complicated by SSI.

SSI caused by RGM following aesthetic surgical procedures is rare. Reports include infection following augmentation mammoplasty procedures4,5 and an outbreak of infection following either face-lift or augmentation mammoplasty procedures that implicated using contaminated gentian violet skin-marking solution as the source of infection.6

The Venezuelan Ministry of Health operates a national program for surveillance of antimicrobial resistance, and some of the large university hospitals occasionally provide rates of specific hospital-acquired infections. However, no active surveillance programs exist for SSI or systematic monitoring of tap water for microorganisms in health-care settings.

To prevent SSI in health-care settings, all surgical instruments used in liposuction or liposculpture procedures should be cleaned carefully after the procedure and sterilized in accordance with a validated reprocessing protocol provided by the medical device manufacturer. The exclusive use of low- or intermediate-level disinfectants to reprocess surgical instruments between patient procedures is inconsistent with the Food and Drug Administration guidance and recommended standards of practice.1,2


References: 6 available




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles