Rapidly growing mycobacteria associated with laparoscopic gastric banding, Australia, 2005-2011

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.

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 12 (patient PB) is indistinguishable from strain 13, isolated from a domestic rainwater tank. #Strain 16 (patient MC) shares 90% similarity with an epidemiologically unrelated domestic bathroom water 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 v. 3.4 PC #675.

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 if the dataset is large and/or if there is no distinct clustering. Gridline spacing: 5% similarity. Source: DiversiLab v. 3.4 PC #675 (bioMérieux, Melbourne, Victoria, Australia).