Epidemiology and Natural History of Non-Tuberculous Mycobacterial Surgical Sites Infections

Abstract

Background. Non-tuberculous mycobacteria (NTM) are mostly nonpathogenic organisms though they can lead to opportunistic infections. NTM surgical site infections (SSIs) have been described in multiple surgical procedures including hernioplasty, laparoscopic surgery, placement of cardiovascular stents, pacemakers, orthopedic surgery, and plastic surgery. Methods. This is a retrospective multi-center case series for a large hospital system in South Texas, conducted from 2012 to May 2016.We collated data from patients with positive cultures for non-tuberculous mycobacteria and who had undergone a surgical procedure within 30 days or up to one year prior to initial presentation with prosthetic device placement. We then performed a descriptive statistical analysis. Results. Eleven cases out of 16 met the criteria for SSI. Most patients were female (7 females versus 4 males). Seven white, 3 Hispanic, and 1 African American. Average age of presentation was 56 years. Most patients (72%) did not have underlying comorbidities. The most common observed comorbidity was diabetes mellitus (two patients), followed by liver cirrhosis (one patient) and immunosuppression (one patient). M. chelonae-abscessus complex was isolated in 6 cases and M. fortuitum in 5 cases. NTM SSI sites were as follows: 7 from abdomen (one left-ventricular-assist-device driveline site and two from sites of pump device), 2 from upper extremities, one from breast abscess, and one from pacemaker pocket site. Eighty-two percent of cases had Infectious Disease consultation and received targeted antimicrobial therapy. Average duration of hospital stay during initial presentation was 7 days, 90% of cases required at least one follow up hospitalization, and all cases required at least one repeat surgical intervention. Only one case experienced recurrence of infection and no deaths were reported. Conclusion. NTM are a rare cause of SSI. We found devices involved in 36% of cases. All needed device exchange which carried significant morbidity and costs. Future larger studies are warranted to address the impact and risk factors of NTM SSI.