Nontuberculous Mycobacteria After Cosmetic Surgery Abroad: What Patients Should Know

What NTM are

Nontuberculous mycobacteria are relatives of the bacterium that causes tuberculosis, but they are a separate group. They don't spread from person to person the way TB does. According to the CDC's clinical overview of NTM (reviewed 2024), more than 190 species are known, and some cause disease in people.

The CDC divides them by how fast they grow in the laboratory. Rapid growers, such as Mycobacterium abscessus, M. chelonae and M. fortuitum, usually grow within 7 to 10 days in culture. Slow growers can take more than 14 days. Both are slow compared with the common bacteria behind most wound infections, which is part of why NTM can be missed.

How NTM get into a surgical wound

The CDC identifies water as the main environmental source. NTM can form biofilms, thin layers of bacteria that are hard to get rid of, in damp places such as pipes. Ordinary drinking water in homes and in healthcare buildings can be a source. Exposure routes the CDC lists include:

• Tap water and non-sterile ice used where sterile products are needed
• Showerheads, faucets and ice machines
• Injections and intravenous infusions
• Devices and equipment that use water

The CDC also notes that large buildings with complex plumbing can have stagnant water, which encourages growth. In a surgical setting, the concern is contaminated water or ice reaching an open wound, an instrument or an injected product.

Why NTM come up so often with cosmetic surgery abroad

The CDC lists cosmetic surgery, dental procedures, injections and medical tourism among the exposures linked to NTM outbreaks. The CDC Yellow Book (2026) specifically describes surgical site infections caused by NTM after cosmetic surgery in the Dominican Republic.

A 2026 CDC review in Emerging Infectious Diseases looked at consultations on adverse outcomes after travel for cosmetic procedures. Of the 20 consultations involving infection, 12 identified confirmed NTM. The study and its limits are covered in our breakdown of the 2026 CDC findings. For this topic, the takeaway is that NTM were the most frequently identified cause of infection in those consultations.

That doesn't mean NTM are common after any particular operation, or that one country is uniquely risky. It means NTM are a known pattern that you and your doctors should keep in mind.

What an NTM wound infection can look like

For skin and soft-tissue infections, the CDC lists signs including:

• Pain and redness at or around the incision
• Nodules (firm lumps) or raised patches under or on the skin
• Ulcers or open sores
• A mass
• A draining tract, where fluid keeps leaking from a spot that won't close

Timing is the other clue. The CDC notes that the time from exposure to symptoms can be long. So an NTM infection may only show up after you're home, when the overseas team is far away and the clinician seeing you may not know your history.

Why ordinary antibiotics may not work

A wound infection after surgery is often treated first with a standard antibiotic aimed at common bacteria. NTM are a different problem. The CDC notes that they are naturally resistant to many antibiotics. A wound that doesn't improve, or keeps coming back after short antibiotic courses, is one reason clinicians consider mycobacteria.

Diagnosis also takes specific steps. The CDC says clinicians should order an acid-fast bacilli (AFB) stain and culture, and that a definitive diagnosis needs a culture from the infected site, such as wound fluid or tissue. Identifying the species can take several weeks. Not every hospital laboratory can do it, so samples may go to a reference laboratory, which also tests which drugs are likely to work.

A routine wound swab sent only for standard bacteria may not find NTM. Mentioning your surgery abroad helps your clinician decide which tests to order.

What treatment generally involves

Treatment is individual, and the CDC recommends involving an infectious disease specialist. In general terms, the CDC describes:

• Combination therapy: usually two to three antimicrobials together.
• Long courses: often six months to a year.
• Surgical or wound care: sometimes needed, especially for infections outside the lungs.

That's why planning matters before you travel. A prolonged infection can mean months of appointments, medication monitoring and possibly more procedures, usually at home and often outside any package or warranty. Our guide on what to do if you develop a complication after returning home covers how to arrange that care.

What to tell a clinician at home

If you have a wound problem after surgery abroad, give the clinician who examines you:

• The country, city and name of the facility where you had surgery
• The dates of surgery and of any injections, drains or wound treatments
• Exactly which procedures were done, including fat grafting or implants
• Every antibiotic you've taken since, with dates and how you responded
• Whether you know of other patients from the same clinic with similar problems

It's reasonable to ask: "Given that I had surgery abroad, should this be tested for mycobacteria?" You're not diagnosing yourself. You're giving the clinician the history they need.

Why reporting matters

NTM outbreaks are often discovered when separate cases are linked back to one facility. The CDC advises clinicians and facilities to report potential NTM infections to infection control staff and to notify health departments of possible outbreaks, and some US states require reporting of NTM infections outside the lungs. The Yellow Book also asks that medical tourism complications be reported to CDC at medicaltourism@cdc.gov. Your clinician will usually handle that. Giving complete details about where you were treated helps it happen.

Who may be at higher risk

The CDC notes that risk is higher in older patients, people with weakened immune systems, people with open wounds and those with other medical conditions. If any of these apply to you, it's another reason to ask about infection prevention before you book, and to take a slow-healing wound seriously afterwards.

If you're being treated for a suspected NTM infection

A long NTM illness can be draining. A few practical steps can make it easier to manage:

• Get your overseas records. Ask the clinic abroad for the operative report, details of any products injected or implanted, and the medications you were given. Your infectious disease team may need them.
• Keep a simple log of wound changes, photos with dates, medications and side effects. Long multi-drug courses usually need monitoring, and a log helps your clinicians make adjustments.
• Don't stop or change medications on your own. Talk to your treating team first, even if the wound looks better.
• Ask about costs early. Find out how your insurance treats care for a complication of surgery done abroad, and whether the overseas provider offers any support.
• Ask whether your case has been reported. This can help identify whether other patients from the same facility are affected.

Questions to ask before surgery

Patients can't inspect a facility's plumbing. You can ask how the clinic tracks and responds to surgical infections, whether it uses sterile water and products for procedures and injections, and what it does when a patient reports a wound problem after going home. For a broader list, see what patients can actually check about infection risk.

Frequently asked questions

Can NTM spread from me to my family?

NTM are generally picked up from the environment, especially water, rather than passed between people the way tuberculosis is. Follow your clinician's wound-care advice, and ask them about any specific concerns at home.

How long after surgery can an NTM infection appear?

The CDC notes that the time from exposure to symptoms can be long, and it doesn't give one fixed timeframe. Because of that, a problem that starts after you're home can still be linked to surgery abroad.

My wound got better on antibiotics, then came back. Could it be NTM?

Possibly, though there are other explanations too. Infections that come back or don't respond are one reason clinicians consider mycobacteria. Tell your clinician about your surgery abroad and ask whether AFB testing is appropriate.

Why is NTM treatment so long?

NTM are naturally resistant to many antibiotics. According to the CDC, treatment usually combines two to three drugs, often for six months to a year, sometimes with surgical wound care. A specialist will tailor the plan.

Does a clean-looking clinic mean NTM aren't a risk?

No. NTM can live in water systems and biofilms that look perfectly clean. What matters is how the facility handles water, ice, sterile products and equipment, and how it responds to infections.