The article by Furuya et al. focuses on surgical site infections (SSIs) after liposuction in the Dominican Republic. The outbreak is likely due to inadequately sterilized liposuction cannulae.
The issue seems to affect a wide variety of cosmetic surgery procedures in countries like Venezuela and the Dominican Republic. It gives rise to the question: is plastic surgery in Venezuela safe ? Breast reductions, breast augmentations tummy tuck, injections into various body sites, face lifts are affected. A CDC report published in MMWR 47(49):1065-7 detected infections with rapidly growing mycobacteria (RGM) in patients from eight different hospitals in Caracas, Venezuela, which cleaned surgical instruments with tap water followed by low level desinfection with a commercial quarternary ammonium solution. These sterilization practices compare very unfavorably with US or European standards in widespread use in the English speaking Caribbean such as use of 2% glutaraldehyde solution followed by steam sterilization in class N autoclaves, possibly with pulse vacuum cycles or similar. It also outlines some of the risks unsuspecting patients face when undergoing cosmetic surgery and plastic surgery in Venezuela and the Dominican Republic, which seem to be particularly deficient in these standards, as the majority of outbreak and case reports in the literature of SSIs with RGMs are linked to those two countries. Are they improving ? Maybe, at least the outbreak reports have given way to the case reports. Is plastic surgery in Venezuela safe now ? Also only a maybe – once they work with sterile instruments !
Another CDC report (MMR 53(23):509) seems to report part of the same outbreak with Mycobacterium abscessus (a RGM) as Furuya et al., albeit the surgical spectrum is different. Breast augmentation, breast reduction, breast lift, abdominoplasty and liposuction are listed as index procedures. Interestingly, nothing specific is reported about the one case of breast augmentation. So it is unknown if implants had to be removed or repeat augmentation was performed once the infection had cleared under prolonged antibiotic treatment. Neither do any of the reports provide data about the total cost of treatment.
So the necessity of using sufficiently advanced sterilization practices must really be emphasized. No corners can be cut here. While not of equal magnitude as the PIP breast implant (Polyimplante Prosthesis breast implants) scandal in Venezuela and Colombia (about 30000 and 14000 recalled implants still in situ), avoidable complications due to inadequate sterilization of surgical instruments and liposuction cannulae the cited outbreaks should caution surgical facilities to implement stringent sterilization and infection control practices. So is plastic surgery in Venezuela safe ? Well, make sure you see them clean and put the instruments in a high end autoclave and have a look at the implants they want to put in before you go.