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Treating Primary Arthroprosthesis Infection Caused by Mycobacterium abscessus subsp. a bscessus
Ist Teil von
Case reports in infectious diseases, 2019-12, Vol.2019, p.1-7
Erscheinungsjahr
2019
Link zum Volltext
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
Prosthetic joint infections (PJI) caused by nontuberculous mycobacteria are very rare, and results of treatment can be unpredictable. A 72-year-old female underwent hip replacement after an accidental fall in a local hospital in Santo Domingo. The postoperative period was uneventful except for a traumatic wound near the surgical scar. PJI caused by
Mycobacterium abscessu
s subsp.
abscessus
was diagnosed 6 months later. A two-stage reimplantation was performed after a 3-month period of aetiology-directed therapy, including amikacin, imipenem, and clarithromycin.
M
.
abscessus
isolate was reported to be resistant to clarithromycin when incubation was protracted for 14 days and to harbour the gene
erm
(41). The patient manifested major side effects to tigecycline. At reimplant, microbiologic investigations resulted negative. Overall, medical treatment was continued for a 7-month period. When discontinued and at 6-month follow-up, the patient was clinically well, inflammatory markers were normal, and the radiography showed well-positioned prosthesis.
Mycobacterium abscessus
subsp.
abscessus
is a very rare cause of PJI, yet it must be included in the differential diagnosis, especially when routine bacteria cultures are reported being negative. Further investigations are needed to determine any correlations between clinical results and
in vitro
susceptibility tests, as well as the clinical implications of
M
.
abscessus
subsp.
abscessus
harbouring the functional gene
erm
(41). Moreover, investigations are needed for determine optimal timings of surgery and lengths of medical therapy to improve patient outcome.