<i>Mycobacterium mageritense</i> Prosthetic Joint Infection

Martinez, Maria A Caravedo; Blanton, Lucas S.

doi:10.1155/2020/8845430

Case Reports in Infectious Diseases

2020

DOI: 10.1155/2020/8845430

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Mycobacterium mageritense Prosthetic Joint Infection

Maria A Caravedo Martinez

Lucas S. Blanton

Abstract: Prosthetic joint infections (PJI) complicate up to 2% of arthroplasties and are usually caused by typical bacterial agents (e.g., staphylococci and streptococci). Although an infrequent cause of PJI, mycobacterial species are difficult to eradicate, as they adhere to hardware, form biofilms, and have high rates of antimicrobial resistance. Mycobacterium mageritense is a rapidly growing Mycobacterium that has been infrequently described as a cause of… Show more

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Cited by 5 publications

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“…Although most cases are successful, prosthetic joint infections (PJIs) complicate 1.7 to 2% of arthroplasty procedures. 1 , 2 , 3 , 4 Culture-negative PJIs are relatively frequent and remain diagnostically challenging. 5 Approximately 60% of PJIs are due to gram-positive cocci, but 5% to 35% of PJIs can remain culture-negative.…”

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confidence: 99%

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Prosthetic Knee Joint Infection Caused by Mycobacterium kansasii

Dasari¹,

Hadro²,

Singh³

et al. 2022

JAAOS Glob Res Rev

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Mycobacterium kansasii is a nontuberculous mycobacterium that is a rare cause of prosthetic joint infections (PJIs). This case report presents a 58-year-old man who developed rapidly progressive arthritis after exposing his right knee to an unknown fluid at a microbial pharmaceutical company. Within a year, he underwent a right total knee arthroplasty (TKA). At 5 months postoperatively, he presented with pain and swelling of that knee. Imaging revealed extensive periprosthetic osteolysis with diffuse intracapsular and posterior extracapsular fluid collections. Multiple knee aspirates had negative cultures, and infectious laboratory test results were equivocal. Two years after his primary arthroplasty, the patient underwent posterior débridement and one-stage revision TKA with antibiotic cement. Synovial fluid mycobacterial cultures aspirated 2 weeks before the revision surgery became positive on postoperative day 1. PCR identified M kansasii. At 3 weeks postoperatively, intraoperative periprosthetic cultures grew mycobacterium. M kansasii was confirmed using mass spectrometry. Once susceptibilities returned, the patient was treated with targeted antimycobacterial therapy. This case report demonstrates the importance of considering atypical PJI in painful TKA with negative cultures and equivocal laboratory results. In the future, when there is concern for an atypical PJI, molecular diagnostic tools and mycobacterial cultures should be used before surgical intervention.

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confidence: 99%

“… 6 A mycobacterial PJI is difficult to manage because of its ability to adhere to implants, its ability form architecturally complex biofilms, and its intrinsic antibiotic resistance. 1 , 3 …”

mentioning

confidence: 99%

Prosthetic Knee Joint Infection Caused by Mycobacterium kansasii

Dasari¹,

Hadro²,

Singh³

et al. 2022

JAAOS Glob Res Rev

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“…3 We encountered rare Mycobacterium(M) mageritense mesh infection, after abdominal herniation repair. M.mageritense [4][5][6] is classified into rapidly growing non-tuberculous mycobacteria (NTM). NTM are environmental mycobacteria.…”

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confidence: 99%

“…7 M.mageritense is considered to be a variant of the M. fortunum group. [4][5][6] But there are only a few reports of skin and soft tissue infections by M. mageritense. 4,5 We report a case of Mycobacterium mageritense mesh infection, treated with NPWT without mesh removal in a ventral hernia.…”

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confidence: 99%

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A Ventral Hernia-repair–related Mycobacterium mageritense Mesh Infection Treated with NPWT without Mesh Removal

Ando

Miyata

Harada

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Abdominal hernias are often repaired using prosthetic mesh, which is susceptible to infections. Normally, it is necessary to remove the mesh. However, successful mesh salvation with negative-pressure wound therapy (NPWT) has recently been reported. We encountered Mycobacterium(M) mageritense infection after hernia repair using the mesh. M. mageritense is classified as a fast-growing nontuberculous mycobacterium, but few cases have been reported. Nontuberculous mycobacterium can cause rare chronic infections. Skin and soft-tissue infections by nontuberculous mycobacterium involving localized abscess formation and chronic abscesses under various situations have been reported. We report an 85-year-old woman in whom a ventral hernia repair-related M. mageritense mesh infection was treated with NPWT without mesh removal. The hernia was repaired using Bard Ventralex mesh. Pus discharge was seen on the seventh postoperative day, and there was a small area of necrosis under the mesh. From the 13th postoperative day, NPWT was performed for 4 weeks. On the 29th postoperative day, a M. mageritense infection was diagnosed, which was resistant to multiple drugs. After the NPWT, most of the wound showed good granulation tissue formation. In conclusion, the mesh used to repair a hernia became infected with M. mageritense, but NPWT was able to salvage it. In cases of mesh infection involving small necrotic areas, performing NPWT under the guidance of an infectious disease expert may make it possible to preserve the mesh.

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Non‐Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature

Maimaiti,

Li,

et al. 2023

Orthopaedic Surgery

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Objective: Periprosthetic joint infection (PJI) caused by non-tubercular mycobacteria (NTM) is uncommon but catastrophic. However, conclusive clinical data on PJI caused by NTM are lacking. In this case series and systematic review, the clinical manifestations, diagnosis, and management of NTM PJI are summarized and analyzed. Methods:From 2012 to 2020, we retrospectively analyzed consecutive PJI cases caused by NTM in our institution.A literature review was also conducted from January 2000 to December 2021, utilizing the PubMed, MEDLINE, Cochrane Library, and EMBASE databases to identify all reported NTM-induced PJI cases. The clinical characteristics, demographics, pathogen identification, treatment protocols, and prognosis of NTM PJI were summarized and analyzed. Results:In this retrospective analysis, seven patients infected with NTM following total joint arthroplasty at our institution were included, including six cases of PJI caused by NTM and one case of septic arthritis (SA) caused by NTM. There were six men and one woman, and their average age was 62.3 years. The average interval between TJA and PJI onset was 4 months. The preoperative serological markers, including the mean ESR (51 mm/h), CRP (4.0 mg/dL), fibrinogen (5.7 g/L), and D-dimer (1.1 g/L), were increased. Six patients underwent staged revision surgery, and one patient with SA received antibiotic-loaded bone cement beads to treat the infection. After an average of 33 months of observation following surgical intervention, none of the patients showed any symptoms of infection recurrence. From 2000 to 2021, 68 patients with NTM PJI were found in 39 studies in the published literature. Reinfections occurred within 1 year after arthroplasty in more than half (53.2%) of the patients. M. fortuitum and M. abscesses were the most prevalent rapidly growing mycobacteria (RGM) in all PJI patients, whereas Mycobacterium avium intracellulare (MAC) was the most prevalent slowly growing mycobacterium (SGM). The corresponding antibiotics were amikacin and ethambutol. The rate of culture-negative without specific clinical symptoms was as high as 36.4% (12/33), while 45% (18/40) utilized additional diagnostic techniques such as NGS. A final clinical follow-up record was available for 59 patients (86.7%; mean follow-up period, 29 months), and 10.1% of patients failed to respond to treatment. Conclusion:Orthopaedic surgeons should consider NTM in patients with negative routine cultures who are at risk for Mycobacterium infection. Treatment options rely on the accurate result of microbiologic identification and drug sensitivity testing, and to achieve this, it may be necessary to send multiple culture specimens, extend the culture time, and change the culture medium. Every effort should be made to identify NTM and its various subtypes through modern diagnostic tools if necessary.

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Mycobacterium mageritense Prosthetic Joint Infection

Cited by 5 publications

References 12 publications

Prosthetic Knee Joint Infection Caused by Mycobacterium kansasii

Prosthetic Knee Joint Infection Caused by Mycobacterium kansasii

A Ventral Hernia-repair–related Mycobacterium mageritense Mesh Infection Treated with NPWT without Mesh Removal

Non‐Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature

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