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

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

Author Nascimento, Heloisa Autor UNIFESP Google Scholar
Viana-Niero, Cristina Autor UNIFESP Google Scholar
Nogueira, Christiane Lourenco Autor UNIFESP Google Scholar
Martins Bispo, Paulo Jose Autor UNIFESP Google Scholar
Pinto, Fernando Autor UNIFESP Google Scholar
Pereira Uzam, Camila de Paula Autor UNIFESP Google Scholar
Matsumoto, Cristianne Kayoko Autor UNIFESP Google Scholar
Oliveira Machado, Antonia Maria Google Scholar
Leao, Sylvia Cardoso Autor UNIFESP Google Scholar
Hofling-Lima, Ana Luisa Autor UNIFESP Google Scholar
de Freitas, Denise Autor UNIFESP Google Scholar
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.
Keywords Mycobacterium chelonae keratitis
nontuberculous mycobacteria keratitis
tap water
xmlui.dri2xhtml.METS-1.0.item-coverage Philadelphia
Language English
Sponsor Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2010/52641-1, 2011/18326-4]
FAPESP [2012/13763-0, 2013/16018-6]
Grant number FAPESP [2010/52641-1, 2011/18326-4]
FAPESP [2012/13763-0, 2013/16018-6]
Date 2018
Published in Cornea. Philadelphia, v. 37, n. 1, p. 116-122, 2018.
ISSN 0277-3740 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 116-122
Access rights Closed access
Type Article
Web of Science ID WOS:000429224800028

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