Identification of the Infection Source of an Outbreak of Mycobacterium Chelonae Keratitis After Laser in Situ Keratomileusis

Author(s):Show less -

Nascimento, Heloisa ^[1] ; Viana-Niero, Cristina ^[2] ; Nogueira, Christiane Lourenco ^[3] ; Martins Bispo, Paulo Jose ^{[1, 4, 5, 6]} ; Pinto, Fernando ^[7] ; Pereira Uzam, Camila de Paula ^[2] ; Matsumoto, Cristianne Kayoko ^[3] ; Oliveira Machado, Antonia Maria ^[8] ; Leao, Sylvia Cardoso ^[2] ; Hofling-Lima, Ana Luisa ^[1] ; de Freitas, Denise ^[1]

Affiliation

^[1] Univ Fed Sao Paulo, Paulista Sch Med, Dept Ophthalmol & Visual Sci, Rua Botucatu 821, BR-04023062 Sao Paulo - Brazil

^[2] Univ Fed Sao Paulo, Dept Biol Sci, Diadema - Brazil

^[3] Univ Fed Sao Paulo, Paulista Sch Med, Dept Microbiol Immunol & Parasitol, Sao Paulo - Brazil

^[4] Harvard Med Sch, Massachusetts Eye & Ear Infirm, Dept Ophthalmol, Boston, MA - USA

^[5] Harvard Med Sch, Massachusetts Eye & Ear Infirm, Dept Microbiol, Boston, MA - USA

^[6] Harvard Med Sch, Massachusetts Eye & Ear Infirm, Dept Immunobiol, Boston, MA - USA

^[7] Univ Fed Sao Paulo, Discipline Clin Pathol, Cent Lab, Sao Paulo - Brazil

^[8] Hosp Sao Paulo, Cent Lab, Sao Paulo - Brazil

• Document type: Journal article
• Source: CORNEA; v. 37, n. 1, p. 116-122, JAN 2018.
• Web of Science Citations: 5

Abstract

Purpose: Nontuberculous mycobacteria keratitis is a rare but challenging complication of laser in situ keratomileusis (LASIK). This study was conducted to determine the source(s) of infection in a cluster of cases of keratitis after LASIK and to describe this outbreak and patients' outcomes. Methods: In this retrospective, case series, single-center study, 86 patients were included who underwent LASIK or photorefractive keratectomy between December 2011 and February 2012. Corneal scrapes from the affected eyes, samples of tap and distilled water, water from the reservoir of the distilling equipment, steamer, and autoclave cassette; antiseptic and anesthetic solutions and surgical instrument imprints were cultivated in liquid and on solid media. Gram-negative bacteria and yeasts were identified using automated systems and mycobacteria by polymerase chain reaction-restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and DNA sequencing. Mycobacterial isolates were typed by pulsed-field gel electrophoresis. The cases and outcomes are described. The main outcome measure was identification of the source(s) of the mycobacterial infections. Results: Eight (15 eyes) of 86 patients (172 eyes) who underwent LASIK developed infections postoperatively; no patients who underwent photorefractive keratectomy developed infections. Mycobacterium chelonae was isolated from 4 eyes. The distilled water collected in the surgical facility contained the same M. chelonae strain isolated from the patients' eyes. Different gramnegative bacteria and yeasts were isolated from samples collected at the clinic but not from the patients' eyes. Conclusions: Tap water distilled locally in surgical facilities may be a source of infection after ocular surgery and its use should be avoided. (AU)

• FAPESP's process: 12/13763-0 - Taxonomic characterization of mycobacteria belonging to Mycobacterium chelonae-M.abscessus group without conclusive species identification
• Grantee: Christiane Lourenço Nogueira
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 13/16018-6 - Sequencing and annotation of the genome from strain EPM 10906, a new mycobacterium species
• Grantee: Cristianne Kayoko Matsumoto
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 11/18326-4 - Mycobacteria and extrachromosomal elements: molecular characterization and biotechnological applications
• Grantee: Sylvia Luisa Pincherle Cardoso Leão
• Support Opportunities: Research Projects - Thematic Grants