Twenty-seven women who needed surgery at Roper Hospital in 2016 and 2017 developed a bacterial infection that required them to undergo more surgery and months of antibiotic treatment.
Most of them acquired the infection after breast reconstruction surgery because they had been diagnosed with breast cancer or had removed their breasts because they carried a gene that predisposed them to cancer. Two patients developed the infection following an abdominal plastic surgery procedure and two more following a procedure related to other cancer treatment.
Todd Shuman, chief physician officer at Roper St. Francis, confirmed Friday that water at Roper Hospital tested positive for non-tuberculous mycobacteria, but he said federal and state health officials have not determined why other surgical patients at Roper Hospital were not infected or how exactly the breast reconstruction patients acquired this bacteria.
Surgeons use sterile water during surgery, he said. It is not clear how these patients were exposed to bacteria found in the regular tap water supply.
Nevertheless, more than two dozen patients developed similar symptoms over several months. After reconstruction, Shuman explained that the women reported feeling a "heaviness" in their breasts. Fluid drained from the area was unusually "rust-colored," indicating an infection was present.
The last infection of non-tuberculous mycobacteria at Roper Hospital was reported 11 months ago, Shuman said. All patients who underwent breast reconstruction surgery there have been notified. Roper St. Francis has since moved all breast reconstruction procedures to its Mount Pleasant Hospital and has installed filters to purify water at the downtown hospital.
Hospital leaders at the Medical University of South Carolina, located next to Roper, were made aware of the situation, he said. He said he believes MUSC alerted the nearby Ralph H. Johnson VA Medical Center.
"We've tried to be completely transparent."
A spokeswoman for the S.C. Department of Health and Environment Control confirmed that the agency was made aware of the issue, too. A letter dated March 16, 2017, to Shuman from the state's epidemiologist threatened Roper St. Francis with a potential public health order if the hospital system did not submit a written plan of action by April 7 of last year.
In a separate document, DHEC issued a public health advisory in July, explaining to providers that the agency was investigating a "cluster" of these infections in the Lowcountry. At one point, assistance from the Centers for Disease Control and Prevention was requested.
Non-tuberculous mycobacteria, or NTM, "are slow-growing bacteria that can be found in surface water, tap water, and soil," the DHEC advisory explained. "Because NTM can be found in tap water, health care providers and facilities are encouraged to evaluate their procedures to ensure that contamination of medical equipment or the surgical field with tap water is not occurring during the pre-operative, operative, or immediate post-operative periods."
Roper St. Francis complied with DHEC's recommendations, Shuman said, which included implementing a water management plan that rids the supply of "bacteria and biofilm," as well as auditing surgeries to ensure safe practices. More than 16,000 surgeries of all kinds are performed at Roper Hospital each year and the vast majority of surgical patients have not developed an infection, he said.
Non-tuberculous mycobacteria falls under an umbrella of bacteria that patients may be exposed to in a health care setting. Many of these bacteria have become particularly tricky to treat because they have developed high resistance to most antibiotics.
Other antibiotic-resistant bacteria have become more common in hospitals than non-tuberculous mycobacteria, cases of which the federal and state government does not require health care providers to report, Shuman said. But this specific bacteria did attract attention in 2016 when the Food and Drug Administration issued a warning about the Stöckert 3T Heater-Cooler System, which is commonly used to heat and cool a patient's blood during heart surgery.
The machine was linked to several severe non-tuberculous mycobacteria cases in Greenville, where some heart surgery patients died from the infection.
None of the Roper Hospital patients have died and the hospital faces no legal threat at this point, Shuman said, but leaders at Roper St. Francis want to raise awareness about the bacteria.
"We think the state ought to know about this. We really think the nation ought to know about this," Shuman said. "It's an opportunity for us to be better in medicine."
A spokeswoman for the VA hospital said the bacteria has not been detected there. A spokeswoman for MUSC was not immediately available on Friday to respond to questions for this article.