Empirical Treatment of Highly Suspected Nontuberculous Mycobacteria Infections Following Aesthetic Procedures

Abstract

BackgroundInfection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen.MethodsA total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement.ResultsAll wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients.ConclusionsNTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

A very rare case of mycobacterium gordonae infection of the breast

“…If there is no clinical improvement of the breast infection despite standard antibiotic therapy, atypical mycobacteria should always be considered as a possible pathogen 4 …”

“…NTM are a large (more than 170 species classified) and diverse group of ubiquitous, acid‐fast organisms, which are much less virulent than M. tuberculosis. They can produce a wide range of diseases, including infections of the skin and soft tissues 3,4 . Rarely, NTM can cause breast infections.…”

“…6,7 If there is no clinical improvement of the breast infection despite standard antibiotic therapy, atypical mycobacteria should always be considered as a possible pathogen. 4 Improved culture techniques and widespread use of molecular techniques in pathogen identification have led to an increased recognition of NTM infections over the past years. 5 First-line treatment is a long-term targeted antibiotic therapy (often six to eight weeks in length), adequate surgical drainage and debridement if the area is extensive or implants are involved, and a multidisciplinary approach in consultation with infectious disease specialists.…”

Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures

“…3). Kim et al [18] also reported a treatment strategy of strongly suspected NTM infections following aesthetic procedures. However, our institution deployed improved strategies of diagnosis and treatment.…”

“…Antibiotics effective against microbial infections-as part of multidrug regimens-should be administered for longer periods. Surgical intervention including debridement, drainage, and massive irrigation can also be effective against such infections [18,19].…”