Preventing Postoperative Atypical Mycobacterial Infection

Purpose: To report a recent outbreak of atypical mycobacterial infection following upper eyelid surgery and the results of a prevention protocol that was successfully instituted to dramatically reduce the infection rate. Methods: This is a multicenter retrospective nonrandomized comparative interventional case series. A chart review of 7 patients who developed atypical mycobacterium infection after undergoing blepharoplasty was conducted. Preventative intervention included exchanging ice compresses for reusable gel packs and substituting tap water with bottled or distilled water for facial cleaning during postoperative care. The main outcome measure was disease incidence. Results: Of the 368 patients who underwent upper eyelid blepharoplasty and/or blepharoptosis repair from December 2014 to May 2015, 7 people developed cutaneous atypical mycobacterium infection with an incidence of 1.9%. Eighty-six percent of patients received clarithromycin as part of their treatment with average treatment length of 2.8 months. Debridement was performed in 71% of the patients. Biopsy was performed in all patients, and all had histopathology showing granulomatous inflammation. A prevention protocol was developed to reduce potential inoculation in the immediate postoperative period, which successfully reduced the infection rate from 1.9% to 0.06% (p = 0.019). Conclusions: Atypical mycobacterium infection, although rare, should be considered as a possible diagnosis in a blepharoplasty patient with delayed development of nodular lesions. Long-term clarithromycin therapy and debridement have shown good outcomes for these patients; however, the best treatment for any infection is prevention. This study provides the first evidence based approach within the ophthalmic literature for reducing the mycobacterium infection rate in blepharoplasty patients. Accepted for publication July 8, 2018. The authors have no financial or conflicts of interest to disclose. Presented, in part, at the ASOPRS 48th Annual Fall Scientific Symposium on November 9–10, 2017 in New Orleans, LA. Address correspondence and reprint requests to Alan E. Oester, Jr, M.D., Wilmington Eye, 1729 New Hanover Medical Park Dr, Wilmington, NC 28403. E-mail: coester@wilmingtoneye.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.