Rafael Silva Duarte, Maria Cristina Silva Lourenço, Leila de Souza Fonseca, Sylvia Cardoso Leão, Efigenia de Lourdes T. Amorim, Ingrid L. L. Rocha, Fabrice Santana Coelho, Cristina Viana-Niero, Karen Machado Gomes, Marlei Gomes da Silva, Nádia Suely de Oliveira Lorena, Marcos Bettini Pitombo, Rosa M. C. Ferreira, Márcio Henrique de Oliveira Garcia, Gisele Pinto de Oliveira, Otilia Lupi, Bruno Rios Vilaça, Lúcia Rodrigues Serradas, Alberto Chebabo, Elizabeth Andrade Marques, Lúcia Martins Teixeira, Margareth Dalcolmo, Simone Gonçalves Senna, and Jorge Luiz Mello Sampaio

An epidemic of infections after video-assisted surgery (1,051 possible cases) caused by rapidly growing mycobacteria (RGM) and involving 63 hospitals in the state of Rio de Janeiro, Brazil, occurred between August 2006 and July 2007. One hundred ninety-seven cases were confirmed by positive acid-fast staining and/or culture techniques. Thirty-eight hospitals had cases confirmed by mycobacterial culture, with a total of 148 available isolates recovered from 146 patients. Most (n = 144; 97.2%) isolates presented a PRA-hsp65 restriction pattern suggestive of Mycobacterium bolletii or Mycobacterium massiliense. Seventy-four of these isolates were further identified by hsp65 or rpoB partial sequencing, confirming the species identification as M. massiliense. Epidemic isolates showed susceptibility to amikacin (MIC at which 90% of the tested isolates are inhibited [MIC90], 8 µg/ml) and clarithromycin (MIC90, 0.25 µg/ml) but resistance to ciprofloxacin (MIC90, >32 µg/ml), cefoxitin (MIC90, 128 µg/ml), and doxycycline (MIC90, >64 µg/ml). Representative epidemic M. massiliense isolates that were randomly selected, including at least one isolate from each hospital where confirmed cases were detected, belonged to a single clone, as indicated by the analysis of pulsed-field gel electrophoresis (PFGE) patterns. They also had the same PFGE pattern as that previously observed in two outbreaks that occurred in other Brazilian cities; we designated this clone BRA100. All five BRA100 M. massiliense isolates tested presented consistent tolerance to 2% glutaraldehyde. This is the largest epidemic of postsurgical infections caused by RGM reported in the literature to date in Brazil.
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