DOI: http://dx.doi.org/10.18203/2349-2902.isj20202835

Management of infections with Mycobacterium other than tuberculosis as a complication of surgical procedures

Bikash Naskar, Sabyasachi Bakshi, Tapas Mandal

Abstract


Background: Atypical Mycobacterium other than tuberculosis (MOTT) have emerged as significant human pathogens, causing post-surgical wound infections. The aim of this study is to assess the causative organisms of such infection and their treatment response.

Methods: After matching the criteria, 28 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture.

Results: Among 28 patients, 16 were females (median age of 45.5 year). Patients had undergone laparoscopic cholecystectomy (n=13), laparoscopic appendicectomy (n=3), laparoscopic hernioplasty (n=2), open appendicectomy (n=2), open mesh hernioplasty (n=7), exploratory laparotomy (n=1). No major comorbidities or immunosuppression was identified. All patients were initially treated with repeated incision and drainage and started conventional antibiotics until culture and sensitivity report was available. All except one patient had culture confirmed MOTT infection. Combination antibiotics (clarithromycin, linezolid and ofloxacin) given for initial 3 months. 12 well responded within 3 months. 9 required additional few months to get complete cure. 4 patients cured after 6 months of treatment and 3 patients did not come for follow up.

Conclusions: Delayed onset chronic wound infection by atypical mycobacteria is preventable. These organisms are not responsive to conventional antitubercular drugs but to specific drug regimens.


Keywords


Chronic postoperative wound, atypical mycobacteria, Mycobacterium other than tuberculosis

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References


Dailloux M, Laurain C, Weber M, Hartemann PH. Water and nontuberculous mycobacteria. Water Res. 1999;33:2219-28.

Wallace RJ Jr, Brown BA, Silcox VA, Tsukamura M, Nash DR, Steele LC, et al. Clinical disease, drug susceptibility, and biochemical patterns of the unnamed third biovariant complex of Mycobacterium fortuitum. J Infect Dis. 1991;163:598-603.

Wallace RJ Jr, Swenson JM, Silcox VA, Bullen MG. Treatment of nonpulmonary infections due to Mycobacterium fortuitum and Mycobacterium chelonei on the basis of in vitro susceptibilities. J Infect Dis. 1985;152:500-14.

Song JY, Sohn JW, Jeong HW, Cheong HJ, Kim WJ, Kim MJ. An outbreak of post-acupuncture cutaneous infection due to Mycobacterium abscessus. BMC Infect Dis. 2006;6:6.

Guevara-Patiño A, Sandoval de Mora M, Farreras A, Rivera-Olivero I, Fermin D, de Waard JH. Soft tissue infection due to Mycobacterium fortuitum following acupuncture:a case report and review of the literature. J Infect Dev Ctries. 2010;4(8):521-5.

Al Soub H, Al-Maslamani E, Al-Maslamani M. mycobacterium fortuitum abdominal wall abscesses following liposuction. Indian J Plast Surg. 2008;41(1):58-61.

Shah AK, Gambhir RPS, Hazra N, Katoch R. Non tuberculous mycobacteria in surgical wounds-a rising cause of concern? Indian J Surg. 2010;72:206-10.

Maurer FP, Castelberg C, von Braun A, Wolfensberger A, Bloemberg GV, Böttger EC, et al. Postsurgical wound infections due to rapidly growing mycobacteria in Swiss medical tourists following cosmetic surgery in Latin America between 2012 and 2014. Euro Surveill. 2014;19(37):1-4

Muthusami JC, Vyas FL, Mukundan U, Jesudason MR, Govil S, Jesudason SR. Mycobacterium fortuitum:an iatrogenic cause of soft tissue infection in surgery. ANZ J Surg 2004;74:662-6.

Murillo J, Torres M, Bofill L, Ríos-Fabra A, Irausquin E, Istúriz R, et al. Skin and wound infection by rapidly growing mycobacteria:an unexpected complication of liposuction and liposculpture. The Venezuelan Collaborative Infectious and Tropical Diseases Study Group. Arch Dermatol. 2000;136:1347-52.

Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Infections with rapidly growing mycobacteria: report of 20 cases. Int J Infect Dis. 2003;7:198-205.

Galea LA, Nicklin S. Mycobacterium abscessus infection complicating hand rejuvenation with structural fat grafting. J Plast Reconstr Aesthet Surg. 2009;62:15-6.

Brown-Elliott BA, Wallace RJ Jr. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002;15:716-46.

Macadam SA, Mehling BM, Fanning A, Dufton JA. Nontuberculous Mycobacterial Breast Implant Infections. Plast Reconstr Surg. 2007;119(1):337-44.

Chaudhuri S, Sarkar D, Mukerji R. Diagnosis and management of atypical myco-bacterial infection after laparoscopic surgery. Indian J Surg. 2010;72(6):438-42.

Jarzembowski JA, Young MB. Nontuberculous mycobacterial infections. Arch Pathol Lab Med. 2008;132:1333-41.

Kim HR, Kim DW. Soft tissue infection with Mycobacterium abscessus on the chin of a healthy child:a case report. J Korean Soc Plast Reconstr Surg. 2010;37:289-92.

Kaltia JB, Rahman H, Baruah KC. Delayed post operative wound infection due to non-tuberculous Mycobacterium. Indian J Med Res. 2005;122:535-9.

Coelho JCU, Claus CMP, Michelotto JC, Fernandes FM, Valle CL, Andriguetto LD, et al. Complication of laparoscopic inguinal herniorrhaphy including one case of atypical mycobacterial infection. Surg Endosc. 2010;24:2708-12.

Haider M, Banerjee P, Jaggi T, Hussain J. Post-operative sinus formation due to Mycobacterium Abscessus. Indian J Tuberc. 2013;60:177-9.

Kannaiyan K, Ragunathan L, Sakthivel S, Sasidar AR. Surgical site infection due to rapidly growing Mycobacteria. J Clin Diagnos Res. 2015;9(3):DC05-8.

Rajkumar JS, Vinoth A, Akbar S, Rajkumar A, Tadimari H, Reddy AJ, et al. Non tuberculous Mycobacterium as a causative factor in port site wound infection. Surg Med Open Acc J. 2018;1(3).SMOAJ.000511.