Mycobacterium abscessus is a highly antibiotic-resistant rapidly growing mycobacteria. We present the first documented case of total hip arthroplasty infection caused by Mycobacterium abscessus and our experience using tigecycline after first-line therapies failed to eradicate the patient's infection. Tigecycline is a new broad-spectrum antibiotic typically used in complicated skin and intra-abdominal infections. Our report highlights the benefits and difficulties of prolonged tigecycline use. This is the first documented curative treatment of M. abscessus infection of any type of prosthetic joint and also the first successful use of tigecycline to treat a rapidly growing mycobacteria prosthetic joint infection of any species in the literature. (Infect Dis Clin Pract 2010;18: 269Y270)M ycobacterium abscessus is the most antibiotic resistant of the rapidly growing mycobacteria (RGM). 1Y3 Mycobacterium abscessus typically causes either pneumonia, often in patients with bronchiectasis and/or cystic fibrosis, or a soft tissue infection when introduced by a contaminated needle or other foreign body. 1,4 Our report adds to the body of literature on RGM prosthetic joint infection (PJI) by describing only the second case of M. abscessus PJI and the first-ever successful treatment. We also describe our experience with use of tigecycline in combination with azithromycin and cefoxitin after initially failing to eradicate the infection with standard first-line therapy of amikacin, azithromycin, and cefoxitin with prosthesis explantation. It is the first reported use of tigecycline to treat an RGM PJI and highlights the potential use of this antibiotic for prosthesis infections and the difficulties involved in using it for a prolonged period.
CASE REPORTA 40-year-old immunocompetent woman underwent total left hip replacement due to posttraumatic arthritis. Twenty-three months later, she presented with low-grade fevers, progressive left hip pain, and swelling. Her white blood cell count was 9500/KL, and erythrocyte sedimentation rate (ESR) was 79 mm/h. A left hip x-ray film showed a mild lucency of the femoral component stem superiorly but no evidence of hardware loosening. Irrigation and debridement of the hip were performed.Intraoperative examination revealed minimal tissue inflammation and small amounts of serous inflammatory fluid.Initial bacterial, fungal, and acid-fast bacillus (AFB) stains were negative for microorganism. However, synovial fluid bacterial and AFB culture grew nontuberculous mycobacteria consistent with an RGM subsequently identified as M. abscessus. In vitro sensitivities showed susceptibility to amikacin, kanamycin, tigecycline, clarithromycin, and azithromycin with intermediate susceptibility to linezolid, cefoxitin, imipenem, and tobramycin.Intravenous amikacin, imipenem, and azithromycin were started. The prosthetic joint was removed and replaced with a tobramycin-impregnated cement spacer. She was discharged on amikacin, cefoxitin, and oral azithromycin. She initially tolerated these medications we...