Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA

Abstract

Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients

Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease

“…Surgical resection. For extra-pulmonary NTM infections, such as skin/soft tissue, musculoskeletal, and lymphadenitis, surgical interventions such as debridement, excision, and drainage of abscesses are often a necessary and important component of the management of these infections [60] , [61] , [62] , [63] , [64] , [65] .…”

Management of refractory Mycobacterium abscessus sternal infection following reoperative cardiac surgery

“…In an effort to deliver a higher concentration of antimicrobials to the affected site, we utilized amikacin beads in addition to systemic therapy. While amikacin beads have previously been described in the treatment of NTM infections, this is, to the best of our knowledge, the first reported use in a NTM sternal infection 4 …”

Treatment of Extrapulmonary Nontuberculous Mycobacterial Diseases

“…NTM diseases involving the musculoskeletal system are rare and their clinical presentations differ with the immune status of the patient. Immunocompetent patients usually present with focal infections in tendon sheaths, bursa, joints, and bones, which are caused by direct inoculation of the organisms through trauma, penetrating injury, needle injection, or contamination during surgical procedures [4748]. Immunocompromised patients often present with vertebral involvement, usually as a component of disseminated disease.…”

“…Several case studies of NTM musculoskeletal infections have been performed [4849]. In a study of 29 cases over 13 years in Korea, all patients required surgical intervention in addition to antibiotics, and the isolates were M. intracellulare in 6 patients, M. fortuitum in 3, M. abscessus in 2, and M. marinum in 1.…”

“…The mean duration of antibiotics was 13.5 months (0.5–60 months) [49]. In a series of 14 cases of nonspinal NTM musculoskeletal infection over 6 years in the USA, all but 1 patient were ultimately cured by combined medical and surgical treatment [48]. Prosthetic joint infection (PJI) (n = 6), septic arthritis (n = 5), osteomyelitis (n = 3), tendon sheath infection (n = 2), skin abscess (n = 2), cellulitis (n = 2), and surgical wound infection (n = 1) were observed.…”