Intervention strategy for Rapid Grower Mycobacteria outbreak among post-laparoscopic surgical site infection patients in a tertiary care hospital.

Abstract

Background & objectives The emergence of Rapid Grower Mycobacteria (RGM) infections recently produced a great challenge among surgeons following laparoscopic surgical site infection. Infections caused by atypical mycobacteria may be overlooked due to limitations of proper diagnostic infrastructure and unawareness in the resource-limited set-up. In this study, we proposed an intervention strategy for RGM infection among patients having post-laparoscopic surgical site infections in our hospital. Methods Five hundred sixty-five samples were collected within one year (April 2018- March 2019) from the surgery outpatient department (OPD), suspecting atypical mycobacteria infection following surgery. Samples were processed in the microbiology department by conventional staining and culture. RGM was diagnosed up to the species level by both conventional and molecular methods [line probe assay (LPA)]. The antibiogram was performed by the microbroth dilution method on the RAPMYCOI kit as per Clinical and Laboratory Standard Institute (CLSI) guidelines. Simultaneous source identification was carried out. Results A biofilm-producing Mycobacterium abscessus strain was detected from the plastic disinfection tray of the surgical operation theatre (OT), which may be the continuous source of iatrogenic post-surgical infection. RGM prevalence among suspected patients was 19.47 per cent, and around 92 per cent of them were from laparoscopic surgery. Antibiotic sensitivity, as per CLSI guidelines, showed most of them (88.8%) were resistant to commonly given antibiotic clarithromycin. Most sensitivity was to antibiotics amikacin, tobramycin, moxifloxacin, and doxycycline. The game-changing intervention related to this outbreak scenario was the introduction of gas-plasma sterilization and maintaining strict asepsis in surgical operation theatre. Interpretation & conclusions Based on the analysed data, we proposed an intervention strategy in our hospital for treating and preventing RGM infection. Such an approach will help arrest the RGM-outbreaks in future.