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

Autor(es):Mostrar menos -

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]

Afiliação do(s) autor(es)

^[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

• Tipo de documento: Artigo Científico
• Fonte: CORNEA; v. 37, n. 1, p. 116-122, JAN 2018.
• Citações Web of Science: 5

Resumo

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)

• Processo FAPESP: 12/13763-0 - Caracterização taxonômica de micobactérias do grupo Mycobacterium chelonae-M. abscessus sem dentificação de espécie conclusiva
• Beneficiário: Christiane Lourenço Nogueira
• Modalidade de apoio: Bolsas no Brasil - Doutorado
• Processo FAPESP: 13/16018-6 - Sequenciamento e anotação do genoma da cepa epm 10906, uma nova espécie de micobactéria
• Beneficiário: Cristianne Kayoko Matsumoto
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 11/18326-4 - Micobactérias e seus elementos extracromossômicos: caracterização molecular e aplicações biotecnológicas
• Beneficiário: Sylvia Luisa Pincherle Cardoso Leão
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 10/52641-1 - Estudo da biodiversidade de micobactérias ambientais isoladas de água bruta e de sistema de distribuição da Fundação Parque Zoológico de São Paulo
• Beneficiário: Cristina Viana Niero
• Modalidade de apoio: Auxílio à Pesquisa - Regular