Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011 - Volume 20, Number 10—October 2014 - Emerging Infectious Disease journal - CDC

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Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011 - Volume 20, Number 10—October 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 10—October 2014

CME ACTIVITY - Synopsis

Rapidly Growing Mycobacteria Associated with Laparoscopic Gastric Banding, Australia, 2005–2011

On This Page

• Medscape CME Activity
• Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2
• Figure 3
• Figure 4

Tables

• Table 1
• Table 2

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Hugh L. Wright , Rachel M. Thomson, Alistair B. Reid, Robyn Carter, Paul B. Bartley, Peter Newton, and Christopher Coulter

Author affiliations: Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia (H.L. Wright);Gallipoli Medical Research Centre, Brisbane (R.M. Thomson); Wollongong Hospital, Woolongong, New South Wales, Australia (A.B. Reid, P. Newton); Pathology Queensland, Brisbane (R. Carter, C. Coulter); QML Pathology, Brisbane (P.B. Bartley); The Prince Charles Hospital, Brisbane (C. Coulter)

Suggested citation for this article

Abstract

Laparoscopic gastric banding is a common bariatric procedure worldwide. Rapidly growing mycobacteria are environmental organisms increasingly seen as pathogens, often in infected prosthetic material. We report 18 cases of infection associated with laparoscopic gastric banding caused by Mycobacterium fortuitum and M. abscessus in Australia during 2005–2011. We identified cases by reviewing positive cultures at the Queensland state reference laboratory or through correspondence with clinicians, and we obtained clinical and epidemiologic data. Eleven cases of M. fortuitum and 7 cases of M. abscessus infection were identified. The port was thought to be the primary site of infection in 10 of these cases. Complications included peritonitis, band erosion, and chronic ulceration at the port site. Rapidly growing mycobacteria can infect both port and band and can occur as either an early perioperative or late infection. Combination antimicrobial therapy is used on the basis of in vitro susceptibilities. Device removal seems to be vital to successful therapy.

The exponential increase in obesity and morbid obesity worldwide has led to a corresponding increase in bariatric surgical procedures to prevent obesity-associated illness and death (1). Laparoscopic gastric banding is a restrictive procedure involving insertion of an inflatable silicon band at the gastric cardia near the gastro-esophageal junction, which enables adjustment of the size of the outlet through the addition or removal of aqueous solution through a subcutaneous port in the abdominal wall. It is the most common bariatric procedure performed in Australia and the United Kingdom (2); perceived advantages include its less technical surgical demands and low rates of perioperative complications (3). More than 11,000 procedures were performed in Australia during 2011 (4). Infection rates are reportedly low (3) but can occur at the site of the subcutaneous port or be associated with the band itself.

Rapidly growing mycobacteria are ubiquitous organisms found in environmental sources, including soil and water. They cause skin and soft tissue infections and pulmonary disease but also have a predilection for causing diseases involving implanted prosthetic material. Infections associated with silicone implants, indwelling intravenous or peritoneal catheters, cardiac devices, and prosthetic joints have been reported (5–8). Isolated cases of mycobacterial infection involving gastric banding have been reported in recent years (9,10). We report 18 cases of rapidly growing mycobacterial infections associated with laparoscopic gastric banding in Australia during 2005–2011.

Dr Wright is an infectious diseases physician at the Royal Brisbane and Women’s Hospital. His research interests include zoonosis and mycobacteria.

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Figures

• Figure 1. Strain typing using Diversilab platform (bioMérieux, Melbourne, Victoria, Australia) and pulsed-field gel electrophoresis of Mycobacterium fortuitum isolates.
• Figure 2. Repetitive sequence–based PCR dendrogram comparing strain types of 2 Mycobacterium abscessus isolates associated with laparoscopic band infections, with a laboratory control strain, and 9 other environmental isolates, Australia. *Isolate...
• Figure 3. Repetitive sequence–based PCR dendrogram demonstrating differences between Mycobacterium fortuitum isolates associated with lap band infections and M. fortuitum isolated from water samples. Scale bar indicates % similarity. Source: DiversiLab...
• Figure 4. Repetitive sequence–based PCR scatterplot demonstrating lap band isolates (circled) relative to other clinical strains of Mycobacterium fortuitum associated with community-acquired and nosocomial infections. Spacing between samples may be distorted...

Tables

• Table 1. Demographic and clinical characteristics of 18 patients with rapidly growing mycobacterial infections complicating laparoscopic gastric band devices, Australia, 2005–2011
• Table 2. Susceptibilities of Mycobacterium spp. isolated in laparoscopic gastric banding to selected antimicrobial agents, Australia, 2005–2011

Suggested citation for this article: Wright HL, Thomson RM, Reid AB, Carter R, Bartley PB, Newton P, et al. Rapidly growing mycobacteria associated with laparoscopic gastric banding, Australia, 2005–2011. Emerg Infect Dis [Internet]. 2014 Oct [date cited]. http://dx.doi.org/10.3201/eid2010.140077

DOI: 10.3201/eid2010.140077