an event · Dominican Rep.The Dominican mycobacterial outbreaks, 2013–14 and 2017

Two multi-state clusters of rapidly growing nontuberculous mycobacteria — environmental bacteria that infect surgical wounds and take months of antibiotics to clear — in United States residents who had cosmetic surgery in the Dominican Republic. The CDC published the first in MMWR in March 2014 and the second in March 2018. They are the longest published outbreak record attached to any destination in this directory.

The first cluster: "As of February 21, 2014, a total of 19 cases were identified from five states (New York, 11; Massachusetts, three; Connecticut, two; Maryland, two; and Pennsylvania, one)." Sixteen were confirmed and three probable. Twelve of the 19 had been operated on at one clinic and seven at seven other Dominican clinics. The commonest operations were liposuction at 74%, abdominoplasty at 58% and breast implantation at 32%. Fourteen were admitted to hospital in the United States and needed repeated corrective surgery and long courses of antibiotics. Of the 16 confirmed, 13 were Mycobacterium abscessus and two M. fortuitum.

The second, three years later, was larger. By 8 November 2017 the CDC had been notified of 52 patients from nine states; 38, or 73%, met the confirmed case definition — "A diagnosed SSI and laboratory evidence confirming the presence of NTM in a U.S. resident who underwent a cosmetic surgery procedure in the Dominican Republic since January 1, 2017." All the confirmed patients were women, operated on between 4 January and 14 July 2017. They named 14 surgeons at seven surgical centres, and 26 of the 32 with information available — 81% — had been operated on at one centre, CIPLA, which closed temporarily on 8 July 2017. Fourteen of 15 with information needed further surgery after returning home. One patient died.

Inference — the shape of both is a practice rather than a person. Rapidly growing mycobacteria live in water and in solutions; a cluster that concentrates in one building and then appears in six others is describing something done in theatres across a city. Neither report reached a denominator — nobody published how many patients travelled for cosmetic surgery to the country in either period — so no rate can be computed from 19 cases or from 38, and this record computes none.

Both CDC reports stand unrevised, at eight and twelve years old. No later Dominican inspection register was read for this record, and no denominator has been published since.