Comprehensive Sterilization Strategy Curbs Rapid-Growing Mycobacteria Outbreak After Laparoscopic Surgery: Indian Study
India: A recent Indian study suggests that implementing a comprehensive intervention strategy—including gas-plasma sterilization and strict aseptic protocols—can effectively arrest outbreaks of rapid-growing mycobacteria (RGM) following laparoscopic surgery. The intervention reduced infections from affecting nearly one-fifth of suspected patients to just one or two cases per month.
The study was published in the Indian Journal of Medical Research in January 2025.
While laparoscopic surgery (LS) aims to reduce postoperative pain and accelerate recovery, the emergence of Runyon group IV rapid-growing mycobacteria (RGM) presents a distressing clinical challenge often overlooked due to limited diagnostic infrastructure and awareness. Addressing the resulting diagnostic dilemmas and patient anxiety, Nupur Pal of the Department of Microbiology at the Institute of Postgraduate Medical Education & Research (IPGMER), Kolkata, West Bengal, India, and colleagues investigated a facility outbreak to establish an effective intervention strategy for these post-laparoscopic infections.
The original outbreak investigation at the institute-level setting evaluated 565 surgery outpatient department (OPD) samples from April 2018 to March 2019, specifically targeting patients with post-laparoscopic abscesses or chronic inflammation nonresponsive to standard antibiotics. Speciation was achieved through Gram and acid-fast bacillus (AFB) staining, Lowenstein-Jensen (LJ) culture, biochemical tests, and line probe assay (LPA), complemented by operating theatre (OT) environmental screening and Clinical and Laboratory Standard Institute (CLSI)-compliant microbroth dilution sensitivity testing.
- Increased Vigilance: The study suggests that clinicians should suspect RGM in non-healing wounds, as the study found a 19.47 percent prevalence among suspected patients, with 88 percent of cases occurring after laparoscopic cholecystectomy.
- Targeted Antibiotics: With 88.8 percent resistance to clarithromycin, clinicians should prioritize amikacin, tobramycin, moxifloxacin, or doxycycline, which all showed 100 percent sensitivity.
- Advanced Sterilization: Adopting gas-plasma sterilization and metal trays to eliminate biofilms successfully reduced surgical site infections to just one to two cases per month.
- Accurate Diagnosis: Mandatory sensitivity testing and combination therapy, such as injectable amikacin with oral moxifloxacin, are essential to prevent misdiagnosing RGM as multidrug-resistant tuberculosis.
- Strict Asepsis: To prevent the spread of Mycobacterium abscessus (the most frequent isolate at 51.28 percent), surgical instruments must undergo mechanical scrubbing and must never be cleaned with tap water.
The results suggest that because Rapid Grower Mycobacteria (RGM) are emerging hospital-acquired pathogens often resistant to standard empiric treatments, clinicians must maintain high diagnostic suspicion, perform mandatory antibiotic sensitivity testing before initiating therapy, and implement stringent infection control protocols to effectively prevent iatrogenic infections and manage outbreaks.
The authors emphasize, "It is mandatory to do an antibiotic sensitivity test before initiation of treatment" to ensure effective patient management and prevent the misclassification of these infections.
Clinically, the study recommends against empirical clarithromycin use, instead suggesting a formulated antibiotic policy of combination therapy, such as injectable amikacin with oral moxifloxacin.
Reference
Pal N, Ray R, Kundu S, Maiti PK. Intervention strategy for Rapid Grower Mycobacteria outbreak among post-laparoscopic surgical site infection patients in a tertiary care hospital. Indian J Med Res. 2024; 160: 625-629.
