1. 13 of 66 patients that underwent liposuction at one particular group’s surgical centers had either confirmed or suspected group A streptococcal (GAS) infections.
2. The source of these infections was traced to two healthcare workers at these facilities, colonized by the same strain of bacteria.
Evidence Rating Level: 2 (Good)
Study Rundown: The authors of this article describe an outbreak investigation of infections associated with liposuction at two outpatient facilities. The investigation was initiated after the Maryland Department of Health & Mental Hygiene (MDHMH) was informed of 3 patients with invasive GAS infections in a hospital, including 1 fatality, all of whom had undergone liposuction at a single outpatient cosmetic surgery facility between August and September 2012. This was a joint investigation by health departments in Maryland, Pennsylvania, and Delaware as the facility was part of a company with facilities in all 3 states. After carrying on the investigation as detailed below, the authors identified 4 confirmed cases and 9 suspected cases equating to an overall attack rate of 20%. They also identified that two team members working at both facilities were colonized by a similar strain of GAS. Coupled with the findings of sub-standard infection control practices found at the centers, the authors conclude that the outbreak was likely caused by transmission from the colonized workers during liposuction procedures.
The strength of the paper lies in the robust investigation performed by the authors. However, serious limitations lie in the investigators’ conclusions. The authors presume that lack of state or federal oversight of these centers was a key cause of the outbreak without proving so. They also suggest that patients should consider the board certification status of physicians. Without actual evidence linking state and federal oversight and board certification to improved outcomes, these are dangerous recommendations that may simply increase the cost of care provided and add unnecessary bureaucratic layers.
In-Depth: All patients that underwent liposuction between July and September of 2012 at the group’s centers were identified and attempted to be contacted. Management and staff at the facilities were also interviewed and employees who participated in the care of the patients with confirmed GAS infections were screened for colonization. Site visits were also performed to assess compliance with standard infection prevention and control practices.
66 total liposuction procedures performed at the centers were identified. Of these, 4 confirmed and 9 suspected GAS infection cases were noted, yielding an overall strike rate of 20%. All 4 confirmed cases had necrotizing fasciitis and one of these patients died. Median duration of hospitalization was 19 days and underwent 2-6 debridement procedures. A single physician had performed liposuction on all patients with confirmed and suspected cases of GAS infections. This physician and a traveling surgical assistant, and both had positive GAS cultures with similar strains.
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