Cosmetic Surgery Linked to NTM Infection Outbreak in Florida: CDC

CDC warns that symptoms of NTM infections from cosmetic surgery could appear up to four months after the procedure

Federal disease experts are calling for health care providers to be mindful of potentially dangerous infections that may develop after cosmetic procedures, following an outbreak of serious postsurgical infections linked to one medical facility in Florida.

Investigators at the U.S. Centers for Disease Control and Prevention (CDC) indicate at least 15 patients across nine different states developed nontuberculous mycobacteria (NTM) infections, after undergoing cosmetic procedures at the same outpatient plastic surgery clinic.

Each of the infected individuals underwent procedures performed by the same surgeon, in an alternative practice location that was being used while the permanent facility was being renovated, according to findings published this week in the latest issue of the Morbidity and Mortality Weekly Report (MMWR).

NTM infections are caused by Mycobacterium abscessus, a rapidly growing and multidrug-resistant bacteria that is known to cause serious skin and soft tissue infections among those who receive cosmetic surgery. The CDC indicates the infections are difficult to treat and usually require an extended course of different antibiotic combinations because they do not respond to conventional infection treatment methods. Officials warn they may not develop until months after a surgery is performed.

NTM Outbreak Linked to Florida Surgery Clinic

The CDC initially became aware of a non-Florida resident who developed an NTM infection in February 2023, after undergoing a cosmetic procedure at a plastic surgery clinic located in south Florida between August and December 2022. An investigation was initiated by the Florida Department of Health (FDOH) in March 2023, which identified additional infections among patients who received procedures from the same facility.

During the investigation, the CDC and FDOH identified at least 15 NTM infections among patients who received cosmetic surgery from the same plastic surgeon, in the same surgical clinic. Investigators used sample testing obtained from patients’ wounds to confirm the bacteria infecting them were closely related and from the same source.

According to the report, all patients were women and between the ages of 24 and 51 years old. The patients reported infection symptoms such as swelling, redness, drainage, or pain around the surgical sites, which started from 33-119 days after undergoing a cosmetic procedure at the clinic. Treatments for the infections included prolonged courses of oral and intravenous antibiotics for up to 2-6 months, as well as wound incisions, drainage, or complete removal of infected tissue.

The CDC indicates the plastic surgeon was performing cosmetic procedures in a temporary location while the permanent facility received renovations, which was promptly closed after officials linked it to the NTM infection outbreak. An on-site infection control inspection of the surgeon’s permanent clinic location was conducted in March 2023, which identified poor infection prevention and control procedures, such as improper cleaning practices, improper use of personal protective equipment, and poor disinfection of surgical devices. Investigators are still working to determine the exact source of the infection-causing bacteria.

CDC officials urge health care providers to be aware that NTM infections may not develop until months after a cosmetic surgery. If they identify an NTM infection, medical professionals should follow existing requirements to notify public health officials, as collaboration among the CDC and other health agencies is critical in identifying further outbreaks.