Mycobacterium abscessus subsp. massiliense infection secondary to traumatic anterior cruciate ligament reconstruction surgery

Abstract

Non-tuberculous Mycobacterium (NTM) infections following knee surgery are rarely reported in the literature. One month after arthroscopic lysis of adhesions from anterior cruciate ligament (ACL) reconstruction, a 67-year-old male patient presented with symptoms suggesting septic arthritis. Empiric antibiotics were initiated. Intraoperative cultures were positive for Mycobacterium abscessus. Organism-specific antimicrobial therapy with azithromycin, amikacin, and imipenem were started. Four months later the patient was switched to oral outpatient treatment with azithromycin, clofazimine and bedaquiline. Mycobacterium infections following ACL reconstruction are exceedingly rare in the United States. Successful management of Mycobacterium abscessus infection is exceptionally challenging for both orthopedists and infection disease specialists.

A Systematic Review of Nontuberculous Mycobacterium Infection Following Anterior Cruciate Ligament Reconstruction

“…1 , Table I). The reported NTM species were M. fortuitum 8 , 9 , M. farcinogenes 10 , and M. abscessus 11 - 13 (Table II). M. fortuitum and M. abscessus are rapidly growing species, and M. farcinogenes is slow-growing.…”

“…Across the reviewed articles, initial postoperative presentation occurred between 3 to 52 weeks, which is consistent with reports on the temporal presentation of NTM infection following a variety of surgical interventions 24 . In 2 of the 6 cases, initial laboratory values were within the normal range and the patient did not demonstrate symptoms suggestive of deep infection 8,13 . Second, NTM are notoriously difficult to grow and identify in the laboratory.…”

“…Second, NTM are notoriously difficult to grow and identify in the laboratory. Positive identification of NTM occurred between 3 and 17 weeks after presentation for postoperative SSI 8 , [10][11][12][13] . In 5 of the 6 cases, the initial cultures (2 arthrocentesis and 3 surgical) failed to identify NTM.…”

“…Oh et al 8 recommended mycobacterial culture for all cases of infection after ACL surgery that had a sinus tract or abscess. Emerson et al 13 recommended early removal of all implants and a prolonged course of antibiotics following positive identification of NTM.…”

“…Emerson et al 13 reported on a 67-year-old man who underwent ACL reconstruction with a quadriceps tendon autograft, femoral suspensory fixation, and a polyetheretherketone (PEEK) interference screw for tibial fixation. At 8 weeks, the knee range of motion had not demonstrated improvement and arthroscopic lysis of adhesions and manipulation under anesthesia A subsequent procedure involving removal of the retained tibial hardware and debridement of the tibial tunnel was performed.…”