Editorial

The 2 cases described in “Mycobacterial Infections Following Cosmetic Surgery Tourism, a Highly Morbid Complication”1 are typical of nontuberculous mycobacterial infections that complicate cosmetic procedures. The authors have described a complication that is probably underreported, given the global business of medical tourism. The relaxation of international borders occurring in the current phase of the COVID-19 pandemic will likely be associated with a resurgence in medical tourism and associated complications. These patients invariably have poor cosmetic results when their surgical procedures have been infected with rapid growing mycobacterial infections. Onset of infection and its subsequent diagnosis are usually delayed.2 Multiple surgical drainages and debridement procedures are required for resolution of infection. The absence of typical wound infection pathogens should lead the practitioner to consider alternative pathogens, such as mycobacteria and fungi. As described by the authors, adjunctive medical therapy for rapidly growing mycobacteria is complicated by few effective choices and significant adverse effects of antibiotics used to treat these infections. Other surgical cosmetic procedures, such as breast and penile implants, can become infected and often require implant removal.3 Rapid growing mycobacteria are ubiquitous in nature.4 Nontuberculous mycobacteria have been isolated from skin marking solutions (gentian violet) and tap water. Any nonadherence to strict surgical guidelines concerning procedures and equipment cleaning and sterilization (suction devices) and irrigation solutions produce high risk situations for patients. Infection can be introduced into the damaged susceptible tissue bed from contaminated irrigation solutions, improperly sterilized suction devices, inadequate skin decontamination, from contaminated antiseptic solutions used in skin preparation, and poor surgical technique. A history of medical tourism should always set off alarm bells for the clinician to consider very broad assessment of risks for their patients and for their hospital population. Sometimes, the presentation of a postoperative wound infection is the first warning to alert the clinician to a range of additional possible risks, including potential exposure to locally acquired infections at the medical tourism destination, sexually transmitted infections, blood borne virus transmission associated with the procedure, and colonization with multidrug-resistant gut flora.5–7 Medical tourism patients should be screened for multiresistant bacteria to circumvent colonization of other patients and hospital staff. Introduction of multiresistant gram-negative organisms can have dire consequences for burns units, intensive care units, and hematology/oncology/transplant units.8