Prosthetic knee joint infection due to Mycobacterium abscessus

Abstract

Infected total knee arthroplasty (TKA) due to Mycobacterium abscessus is very rare with only three such cases described in literature. Only one case was managed successfully, however, with a prolonged course of anti tubercular therapy. In this case report, we present an elderly lady with infected TKA after 2 years of the primary procedure. Although initially it grew different bacteriae, M. abscessus was isolated during the second debridement. She was successfully treated with total of 5 months of second line anti tubercular drugs with revision prosthesis performed during chemotherapy. Two years followup revealed satisfactory outcome with no relapse.

Treating Primary Arthroprosthesis Infection Caused byMycobacterium abscessussubsp. abscessus

“…M. abscessus complex most commonly causes skin, soft tissue, and pulmonary infections; however, any human tissue can be involved. e complex rarely has been reported to cause PJI, and usually it is in the early postoperative period [10][11][12][13][14][15][16]24]. In our patient, clinical symptoms started within 3 months from surgery, and it is not clear if the prosthesis infection occurred when it was first implanted or afterwards, when the patient reported a traumatic skin wound and eventually tissue exposition to mycobacteria present in tap water or in the environment.…”

“…With regard to treatment, the past studies have reported correlations between treatment protocols and outcomes for NTM prosthetic joint infections. Nevertheless, there are no treatment protocols relating to in vitro susceptibility tests, gene studies, and the clinical response, especially when M. abscessus PJI is diagnosed [10][11][12][13][14][15][16][23][24][25]. Overall, in order to treat the patient and prevent recurrence, there is an agreement that a combination of antibiotics and a longcourse therapy are best indicated.…”

“…Overall, in order to treat the patient and prevent recurrence, there is an agreement that a combination of antibiotics and a longcourse therapy are best indicated. Among the antibiotics, amikacin is reported to lead to good outcome, together with clarithromycin, fluoroquinolones, and imipenem [10][11][12][13][14][15][16][23][24][25]. However, M. abscessus is a complex and comprises three different subspecies: M. abscessus subsp.…”

“…With regards to mycobacterial aetiology, routine cultures can lead to false-negative results. Moreover, infections caused by mycobacteria, including M. tuberculosis and NTM, are rare and results of treatment can be unpredictable [7][8][9][10][11][12][13][14][15]. ere is a paucity of results in the literature on the treatments and outcomes of mycobacterial PJI [16]; likewise, there are a limited number of publications on PJI caused by M. abscessus complex.…”

Mycobacterium abscessus Prosthetic Joint Infections of the Knee

“…[2] In an investigation of an outbreak of NTM PJI in Oregon from 2010 -2016, infections were even associated with the presence of a surgical instrument representative present in the operating room during the procedures. [3] Review of the literature [4][5][6][7][8][9] yields a total of 7 additional cases of M. abscessus PJI of the knee (Table S1). The clinical presentations of RGM PJIs are similar to musculoskeletal NTMI of the lower extremities where subacute arthritis may progress to osteomyelitis.…”