Mycobacterial central venous catheter tunnel infection: a difficult problem

Abstract

Summary:We report our experience of non-tuberculous mycobacterial infection associated with the tunnel of Hickman-Broviac central venous catheters in immunosuppressed patients with haematological malignancies undergoing high-dose chemotherapy supported by BMT. The problem is rare and difficult to treat. Our cases are unique in developing tunnel site mycobacterial infection well after the tunnelled catheters were removed. We diagnosed one case of Mycobacterium chelonae, which is a well-documented cause of such infections, and two cases of Mycobacterium haemophilum, which are the first reported cases in this setting. Early wide surgical excision of the infected tunnel site and prolonged antibiotic therapy is necessary. Despite these measures recurrence occurred in two cases. Close liaison with the microbiology laboratory is needed to ensure the appropriate culture media and conditions are used for these fastidious organisms. Empiric antibiotic regimens should be based on the likely organism. Drugs active against M. chelonae and M. haemophilum should be included. Keywords: mycobacteria; central venous catheter; Hickman line; infection; M. chelonae; M. haemophilum Tunnelled venous access devices are used commonly in bone marrow transplantation to allow long-term venous access. These lines are associated with infectious and thrombotic complications. Mycobacterial infections are rarely encountered. Tunnel-related infection is even less frequently reported. We discuss the problem, outline our experience and review the literature.

High rates of infection and colonization by nontuberculous mycobacteria after allogeneic hematopoietic stem cell transplantation

“…Both Mycobacterium tuberculosis and nontuberculous mycobacteria (NTM) are well-described pathogens in alloSCT recipients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, distinguishing infection from colonization by NTM such as Mycobacterium avium complex (MAC) can be difficult, as infection by organisms other than NTM and noninfectious conditions such as graft-versus-host disease (GvHD) can mimic NTM infection in alloSCT recipients. Formal diagnostic criteria for NTM infection ( Figure 1) have been established by the Centers for Disease Control and Prevention (CDC) and the American Thoracic Society but remain controversial.…”

Nontuberculous mycobacterium infection in a burn ICU patient

“…Rapidly growing mycobacteria are of great interest as these NTM are a group of environmental organisms which can cause disease in humans. These organisms commonly cause localized skin and soft tissue infections [7], intravascular catheter infections [8], disseminated infection, osteomyelitis, peritonitis [9,10], endocarditis [11], and bacteremia [12]. Although infections with this group of organisms may occur sporadically, outbreaks have also been reported.…”

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

“…As with many emerging infections in immunosuppressed patients, varied clinical presentations will likely be reported. Recent examples include a central venous catheter tunnel infection in a bone marrow transplant recipient [15] and pyomyositis in a patient receiving long-term steroids for polymyositis [16]. The diagnosis of M. haemophilum infections must be considered early in a patient's course so that appropriate culture conditions can be established.…”