REPORT ON AN OUTBREAK OF POSTINJECTION ABSCESSES DUE TO MYCOBACTERIUM-ABSCESSUS, INCLUDING MANAGEMENT WITH SURGERY AND CLARITHROMYCIN THERAPY AND COMPARISON OF STRAINS BY RANDOM AMPLIFIED POLYMORPHIC DNA-POLYMERASE-CHAIN-REACTION

An outbreak of postinjection abscesses occurred in Barranquilla, Colom bia, and was associated with local injections of lidocaine given in a single physician's office. Over a 5-month period, 350 (18%) of similar to 2,000 injected patients developed localized cutaneous abscesses or cellulitis; of 210 abscess specimens that were cultured, 205 were pos itive for rapidly growing mycobacteria, subsequently identified as Myc obacterium abscessus. The source of the outbreak was not identified. M . abscessus could not be characterized by pulsed-field gel electrophor esis, but all isolates were identical in terms of drug and heavy metal resistance patterns and random amplified polymorphic DNA PCR profiles . We believe this is the first report of the use of this latter techni que for investigation of an outbreak due to M. abscessus, Therapy with a combination of surgical excision and 3-6 months' administration of clarithromycin was successful for 95% of 148 patients treated in this manner; in contrast, therapy was successful for less than one-third of patients treated with surgery alone or clarithromycin alone. This is the largest of the nine known outbreaks of postinjection abscesses tha t have occurred due to rapidly growing mycobacteria and is the first i n which an effective method of therapy was demonstrated.