Nosocomial Outbreak of Port-site Infection due to Atypical Mycobacteria following Laparoscopy: Suggested Infection Control Strategies

Abstract

Introduction: Atypical mycobacteria can survive in conditions that make them hard to eradicate, despite using the standard decontamination procedures and protocols. Thus, errors in sterilisation techniques for laparoscopic instruments can be responsible for outbreaks caused by such bacteria and make it a problem mainly affecting developing countries including India. Aim: To investigate the outbreak of postlaparoscopic wound infection caused by atypical mycobacteria. Materials and Methods: An institution based cross-sectional study was conducted over a two-month period from January 2020 to February 2020. A total of 14 patients presented with postlaparoscopic surgical site wound infections were evaluated with Ziehl-Neelsen (ZN) staining and pus culture on Lowenstein Jensen (LJ) medium and subsequently treated with appropriate antibiotics. For further investigation of the outbreak, environmental samples were collected and isolation rates (percentage) of atypical mycobacteria from these samples were analysed. Results: All the patients included in the study were diagnosed with postlaparoscopic surgical site wound infections caused by atypical mycobacteria. Infection control investigation of the Operation Theatres (OTs) revealed multiple sources of atypical mycobacterial contamination viz., laparoscopic surgical instruments, used disinfectant (gluteraldehyde disinfectant solution) and tap aerators. Conclusion: Negative routine bacterial culture report of samples collected from port-sites should be further investigated for other aetiology e.g., atypical mycobacteria which do not grow on routine bacterial culture. Since high indices of suspicion followed by timely and efficient management of patients with postlaparoscopic surgical site infection are of critical importance.

Keywords

• laparoscopic wound infections
• non-tuberculous mycobacteria
• used disinfectant