Mycoplasma hominis deep wound infection after neuromuscular scoliosis surgery: the use of real-time polymerase chain reaction (PCR)

Krijnen, Matthijs R.; Hekker, T. A. M.; Algra, Johan; Wuisman, P.; Royen, Barend J. van

doi:10.1007/s00586-005-0055-y

Cited by 15 publications

(13 citation statements)

References 29 publications

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“…It is usually responsible for genitourinary tract infections and gynecological surgical wounds infections [13,14]. A review of extragenital infections involving M. hominis revealed that they fall into five categories: septicemia, joint infections, central nervous system infections, respiratory tract infections, and wound infections (particularly after surgery) [15].…”

Section: Discussionmentioning

confidence: 99%

“…Most of the patients were found to be debilitated or immunocompromised before the infection developed [16]. Three cases of M. hominis infection were reported in literature after scoliosis surgery [13,15]. Two cases of retroperitoneal abscess due to M. hominis have been reported, one in a polytraumatized man, and the other one postpartum [17,18].…”

Section: Discussionmentioning

confidence: 99%

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An uncommon case of Mycoplasma hominis infection after total disc replacement

Flouzat-Lachaniette¹,

Guidon²,

Allain³

et al. 2012

Eur Spine J

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Purpose Beside mechanical complications, the majority of adverse events after total disc arthroplasty (TDA) are related to the surgical approach. Septic complications are very uncommon and only one previous case has been published. The objective of this article is to describe the clinical circumstances, treatment, and outcomes of septic complication after TDA at L4-L5, involving an uncommon pathogen (Mycoplasma hominis). Methods A 38-year-old woman underwent a MobiDisc Ò TDA at L4-L5 level for discogenic pain. One month postoperatively, she complained of acute low back and abdominal pain associated with fever (39°C). C-reactive protein level was elevated (197 mg/L; normal \5 mg/L) and the white blood cell count was normal (7 9 10 9 /L; normal 4-10 9 10 9 /L). A computerized tomography (CT) showed a left psoas-based retroperitoneal abscess. Treatment consisted of open debridement, drainage and empirical antibiotic therapy. Intraoperative cultures yielded M. hominis after 7 days incubation. Antibiotic therapy was adapted and discontinued after 2 months. The patient had failed to mention earlier that she had been suffering from abnormal vaginal discharge for some time and was using an intrauterine contraceptive device. Results At 1.5-year follow-up, review confirmed healing of the infection with biological normalization without residual collection, radiolucent lines or osteolysis around the prosthesis at radiographs, CT and MRI.Conclusions Mycoplasma hominis can be involved as an extragenital pathogen in musculoskeletal infections. Because its culture and identification are difficult, special media and real-time PCR are required in case of postoperative deep wound infection after anterior lumbar spine surgery, especially in the case of previous genitourinary infections, to decrease the delay in diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An uncommon case of Mycoplasma hominis infection after total disc replacement

Flouzat-Lachaniette¹,

Guidon²,

Allain³

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…The organism lacks a cell wall and instead has a 3-layer sterol membrane, so it does not appear on Gram stain. 13 To culture M. hominis, specialized media containing animal serum are needed. 14 Polymerase chain reaction (PCR) may be the most sensitive method for diagnosis, but it is not routinely performed.…”

mentioning

confidence: 99%

“…14 Polymerase chain reaction (PCR) may be the most sensitive method for diagnosis, but it is not routinely performed. 13 For these reasons, diagnosis is often delayed. Because it is an atypical bacterium, M. hominis does not respond to common empirical antibiotics, which act on cell wall metabolism.…”

mentioning

confidence: 99%

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Postoperative Mycoplasma hominis infections after neurosurgical intervention

Whitson¹,

Ball²,

Lollis³

et al. 2014

PED

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Object Mycoplasma hominis is a rare cause of infection after neurosurgical procedures. The Mycoplasma genus contains the smallest bacteria discovered to date. Mycoplasma are atypical bacteria that lack a cell wall, a feature that complicates both diagnosis and treatment. The Gram stain and some types of culture media fail to identify these organisms, and typical broad-spectrum antibiotic regimens are ineffective because they act on cell wall metabolism. Mycoplasma hominis commonly colonizes the genitourinary tract in a nonvirulent manner, but it has caused postoperative, postpartum, and posttraumatic infections in various organ systems. The authors present the case of a 17-year-old male with a postoperative intramedullary spinal cord abscess due to M. hominis and report the results of a literature review of M. hominis infections after neurosurgical procedures. Attention is given to time to diagnosis, risk factors for infection, ineffective antibiotic regimens, and final effective antibiotic regimens to provide pertinent information for the practicing neurosurgeon to diagnose and treat this rare occurrence. Methods A PubMed search was performed to identify reports of M. hominis infections after neurosurgical procedures. Results Eleven cases of postneurosurgical M. hominis infection were found. No other cases of intramedullary spinal cord abscess were found. Initial antibiotic coverage was inadequate in all cases, and diagnosis was delayed in all cases. Multiple surgical interventions were often needed. Once appropriate antibiotics were started, patients typically experienced rapid resolution of their neurological symptoms. In 27% of cases, a suspicious genitourinary source other than urinary catheterization was identified. Conclusions Postoperative M. hominis infections are rarely seen after neurosurgical procedures. They are typically responsive to appropriate antibiotic therapy. Mycoplasma infection may cause prolonged hospitalization and multiple returns to the operating room due to delay in diagnosis. Early clinical suspicion with appropriate antibiotic coverage could help prevent these significant complications.