Healthcare-Associated Mycobacterial Port-Site Infections Following Laparoscopic Surgery: Clinical Characteristics and Epidemiological Evidence from a Multicenter Cohort in Bangladesh
Keywords:
Port-site infection; laparoscopic surgery; healthcare-associated infection; mycobacterial infection; nontuberculous mycobacteria; surgical-site infection; Bangladesh; outbreak investigation.Abstract
Introduction: Healthcare-associated mycobacterial infection is an uncommon but important complication of minimally invasive surgery. Delayed port-site infection after laparoscopy may be misclassified as persistent bacterial surgical-site infection, especially in settings where mycobacterial culture and molecular testing are not routinely available. This study reanalyzes a multicenter Bangladeshi cohort of delayed non-healing port-site lesions using a more conservative epidemiological framework of probable healthcare-associated mycobacterial infection. Methods: This retrospective multicenter observational cohort study reviewed 483 laparoscopic procedures performed by six experienced laparoscopic surgeons in five hospitals in Narayanganj, Bangladesh, from September 2020 to January 2021. Patients with delayed non-healing port-site ulcers, abscesses, or discharging sinuses who underwent histopathological evaluation and improved after anti-tubercular therapy were included. Categorical variables were analyzed using the Pearson chi-square test and Cramer’s V.
Results: Among 483 laparoscopic procedures, 87 patients developed port-site infection and 66 fulfilled the inclusion criteria. Female patients accounted for 64 cases (96.97%). Laparoscopic cholecystectomy was the most common associated procedure (54/66, 81.82%), followed by laparoscopic appendectomy (9/66, 13.64%). Abscess was the commonest presentation (41/66, 62.12%), followed by discharging sinus (25/66, 37.88%). Histopathology showed granulomatous inflammation in 56 patients (84.85%) and non-specific inflammation in 10 patients (15.15%). The highest number of cases occurred after operations performed in October 2020 (45/66), and the interval from surgery to presentation ranged from 28 to 65 days. The month of operation was significantly associated with port-site involvement (Pearson chi-square = 33.82, p = 0.0133). Perioperative antibiotic regimen was also associated with the type of subsequent intervention (Pearson chi-square = 23.68, p = 0.0006), although this association was considered non-causal and confounded by operative indication and clinical severity. All patients improved after anti-tubercular therapy.
Conclusion: The delayed onset, temporal clustering, granulomatous histopathology, and response to anti-mycobacterial therapy strongly suggest a probable healthcare-associated mycobacterial outbreak after laparoscopic surgery. In the absence of microbiological confirmation, the broader term “probable mycobacterial port-site infection” is more scientifically defensible than “confirmed port-site tuberculosis”. Strengthening instrument reprocessing, outbreak surveillance, and mycobacterial diagnostic capacity is essential for patient safety in high-burden, resource-limited settings.
Journal of Surgical Sciences 2024;28(1): 20-27
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