Failure among Patients with Non-Tuberculous Mycobacterial Infections in Skin, Soft Tissue, and Musculoskeletal System in Southern Taiwan, 2012–2015

Hsueh, Jung Hua; Fang, Szu Yun; Hsieh, Yu Hsuan; Chen, Lee Wei; Lee, Susan Shin Jung

doi:10.1089/sur.2018.314

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…In this study, the proportion of SSTIs was 11.4%, and the percentage of NTM among mycobacterial isolates also increased significantly from 32.3% to 49.8%. According to another single-center study in Southern Taiwan, the incidence of NTM infection of the skin, soft tissue, and musculoskeletal tissue was 23.6 per 100,000 inpatients 15 . However, their study included patients with other deep musculoskeletal infections such as osteomyelitis and septic arthritis, which was not considered in our study.…”

Section: Discussionmentioning

confidence: 97%

“…Local recurrence was defined as infectious symptoms occurring at the same site as the NTM isolate culture and abnormal laboratory findings, including abnormal white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Treatment failure was defined as local recurrence, secondary disseminated disease, or death related to NTM infection 15 …”

Section: Methodsmentioning

confidence: 99%

“…Treatment failure was defined as local recurrence, secondary disseminated disease, or death related to NTM infection. 15…”

Section: Definition Of Treatment Outcomementioning

confidence: 99%

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Risk Factors for Treatment Failure in Skin and Soft Tissue Infections Caused by Nontuberculous Mycobacteria

2023

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Background: This study investigated the characteristics of patients with skin and soft tissue infections (SSTIs) caused by nontuberculous mycobacteria (NTM) and identified the risk factors for treatment failure in these patients. Material and Methods: Data of patients with NTM SSTIs who received treatment between January 2014 and December 2019 at Taipei Veterans General Hospital were collected retrospectively. Possible risk factors were determined using univariate and multivariate analysis with logistic regression models. Results: A total of 47 patients (24 male, 23 female; age, 57.1 ± 15.2 years) were enrolled. Type 2 diabetes mellitus was the most common comorbidity. The most common mycobacterial species was the Mycobacterium abscessus complex, and the most commonly affected site was the axial trunk. Treatment was successful in 38 patients (81%). Six patients had recurrent infections (13%) after the treatment course was completed, and 3 patients (6.4%) died of NTM-related infection. Delayed treatment for more than 2 months and antibiotic-alone treatment were 2 independent risk factors for treatment failure of NTM SSTIs. Conclusions: Delayed treatment for more than 2 months and antibiotic-alone treatment were associated with a higher failure rate in patients with NTM SSTIs. Therefore, the differential diagnosis of NTM infection should always be considered when the treatment course is prolonged but not effective. Early identification of causative NTM species and appropriate antibiotic treatment may lower the risk of treatment failure. Prompt surgical treatment is suggested if available.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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Risk Factors for Treatment Failure in Skin and Soft Tissue Infections Caused by Nontuberculous Mycobacteria

2023

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“…Of note, the strains of some organisms such as B. henselae, V. vulnificus, M. tuberculosis, and NTM were identified by mNGS; these strains are fastidious or time-consuming to culture. SSTI is the most common manifestation of extrapulmonary NTM disease and identifying the causative NTM species is significantly related to improved clinical outcomes of NTM with SSTI (Uslu et al, 2019;Hsueh et al, 2019). Meanwhile, most Vibrio are associated with severe SSTIs and sepsis and therefore require early and exact pathogen diagnosis (Fei et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

The clinical value of metagenomic next-generation sequencing in the microbiological diagnosis of skin and soft tissue infections

Wang¹,

Miao²,

Pan³

et al. 2020

International Journal of Infectious Diseases

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Background: Metagenomic next-generation sequencing (mNGS), with its comprehensiveness, is widely applied in microbiological diagnosis. Etiological diagnosis is of paramount clinical importance in patients with skin and soft tissue infections (SSTIs). However, the clinical application of mNGS in SSTIs is relatively less studied. Materials and methods: From April 1, 2017 to December 31, 2019, 96 SSTI cases were collected. The positive rates of pathogens detected by mNGS and culture were compared by analyzing tissue samples, pus, swabs, and/or interstitial fluids obtained from the infected parts. Modification of the antibiotic treatment strategy due to mNGS was also assessed. Results: The sensitivity of mNGS for detecting pathogens in SSTI cases was superior to that of culture testing (67.7% vs 35.4%; p < 0.01). Significantly higher identification rates for viruses (10.4% vs 0.0%; p < 0.01) and anaerobes (11.5% vs 1.0%; p < 0.01) were obtained with mNGS compared to culture. Of note, rare pathogens such as Vibrio vulnificus and Bartonella henselae were also detected by mNGS. Importantly, the proportion of multi-pathogen SSTIs detected by mNGS was higher than that of multi-pathogen SSTIs detected by culture (16.7% vs 6.3%; p = 0.035). The rate of targeted antibiotic treatment was significantly higher in mNGS-positive cases than in mNGS-negative cases (41.7% vs 3.8%; p < 0.01). In culture-negative and mNGS-positive cases, the improvement rate was higher than that in mNGS-negative cases, but this was not statistically significant (75.0% vs 73.1%; p = 0.864). Conclusions: mNGS is a promising tool for the etiological diagnosis of SSTIs, particularly in identifying viruses, anaerobes, and multi-pathogen infections. The application of mNGS testing in clinical practice could change antibiotic treatment strategies and partly benefit clinical outcomes.

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“…Previous case reports and case series published on musculoskeletal NTM infections have focused on the risk factors, clinical manifestations, diagnosis, treatments, and outcomes ( Garcia et al, 2013 ; Lin et al, 2014 ; Park et al, 2014 ; Nguyen et al, 2015 ; Wood et al, 2015 ; Kuntz et al, 2016 ; Gundavda et al, 2017 ; Yoon et al, 2017 ; Holt and Kasperbauer, 2018 ; Goldstein et al, 2019 ; Hsueh et al, 2019 ; Napaumpaiporn and Katchamart, 2019 ; Kwan and Tupler, 2021 ). In a series of 28 cases reported in Thailand ( Napaumpaiporn and Katchamart, 2019 ), 25% of the cases presented with previous musculoskeletal trauma, 18% presented with prior subjection to bone and joint surgery, 14% presented with prosthetic joint replacement, and 11% presented with HIV infection.…”

Section: Introductionmentioning

confidence: 99%

Non-tuberculous Mycobacterial Infection of the Musculoskeletal System Detected at Two Tertiary Medical Centres in Henan, China, 2016–2020

Chen²,

Yang³

et al. 2021

Front. Microbiol.

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Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal system is rare but poses a grave threat to public health. These infections yield non-specific symptoms that remain undetected until the development of the later stages of the disease. In this study, we performed a retrospective review of 25 cases of musculoskeletal NTM infection at two tertiary medical centres over a 5-year period to determine the clinical features and improve the current clinical diagnosis and treatment. The most common mycobacterial species detected were Mycobacterium fortuitum in eleven patients, Mycobacterium abscessus in eight patients, Mycobacterium houstonense in three patients, Mycobacterium avium in two patients, and Mycobacterium smegmatis in one patient. The sites of infection included the limbs and joints, most commonly the knee (ten patients) and foot (six patients). The median duration from the onset of symptoms to diagnosis was 2.5 months (0.8–13.5 months). Deep sinus tracts extending to the surgical site were observed in 60% of the patients (15/25), and granulomatous inflammation and granulomatous inflammation with necrosis occurred in 60% of the patients (15/25). All patients underwent surgical treatment for infection control, and all patients, except one, received antimycobacterial therapy based on drug sensitivity assays. The median duration of the antimicrobial chemotherapy was 5 months (range: 3–20 months). At the final follow-up, 24 patients presented with absence of recurrence and one patient succumbed owing to heart failure after debridement. Our findings highlight the importance of vigilance and improvements in the diagnostic methods for musculoskeletal NTM infection. Aggressive surgical treatment and antimycobacterial drug treatment can help achieve satisfactory results.

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Failure among Patients with Non-Tuberculous Mycobacterial Infections in Skin, Soft Tissue, and Musculoskeletal System in Southern Taiwan, 2012–2015

Cited by 8 publications

References 28 publications

Risk Factors for Treatment Failure in Skin and Soft Tissue Infections Caused by Nontuberculous Mycobacteria

Risk Factors for Treatment Failure in Skin and Soft Tissue Infections Caused by Nontuberculous Mycobacteria

The clinical value of metagenomic next-generation sequencing in the microbiological diagnosis of skin and soft tissue infections

Non-tuberculous Mycobacterial Infection of the Musculoskeletal System Detected at Two Tertiary Medical Centres in Henan, China, 2016–2020

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