From the Guidelines
Yes, Mycobacterium abscessus can cause cutaneous ulcers. M. abscessus is a rapidly growing nontuberculous mycobacterium that can infect the skin, causing chronic, non-healing ulcers or abscesses, as stated in the official ATS/IDSA statement 1. These skin infections typically occur after trauma, surgery, or injection procedures that introduce the bacteria into the skin or soft tissues.
Key Considerations
- Treatment of M. abscessus skin ulcers usually requires a combination of antibiotics for several months, often including:
- Clarithromycin or azithromycin
- Amikacin
- Cefoxitin or imipenem
- Surgical debridement may also be necessary in some cases to remove infected tissue and promote healing, as recommended in the guidelines 1.
- M. abscessus is notoriously difficult to treat due to its natural resistance to many antibiotics, with isolates being uniformly resistant to standard antituberculous agents 1.
- The bacteria can form biofilms and survive inside host cells, making eradication challenging, and prolonged antibiotic therapy is typically required, with a minimum of 4 months of therapy necessary to provide a high likelihood of cure 1.
Patient Risk Factors
- Patients with compromised immune systems or chronic lung diseases are at higher risk for M. abscessus infections.
- Proper wound care and avoiding potential sources of contamination (like certain types of water exposure) can help prevent infections in susceptible individuals.
Treatment Approach
- Treatment should be guided by antimicrobial susceptibility testing to ensure the most effective regimen is used, as the efficacy of medication regimens for nonpulmonary disease, such as skin ulcers, can be improved with combination therapy 1.
From the FDA Drug Label
Mycobacterium abscessus The FDA drug label does not answer the question.
From the Research
Mycobacterium abscessus and Cutaneous Ulcers
- Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium that can cause skin infections, including cutaneous ulcers 2, 3, 4.
- The presentation of cutaneous ulcers caused by Mycobacterium abscessus can vary, but they are often characterized by chronic, nonhealing wounds that fail to respond to initial treatment 2, 3.
- Mycobacterium abscessus infection can occur after trauma or surgery, and can also be acquired through contact with contaminated water or other products 3, 5, 6.
Clinical Manifestations
- Cutaneous mycobacterial infections, including those caused by Mycobacterium abscessus, can manifest with a broad range of clinical phenotypes, including cellulitis, single or multiple abscesses, subacute or chronic nodular lesions, macules, superficial lymphadenitis, plaques, nonhealing ulcers, necrotic plaques, and verrucous lesions 5.
- The diagnosis of cutaneous mycobacterial infections, including those caused by Mycobacterium abscessus, is challenging and requires a low threshold of clinical suspicion for obtaining skin biopsies of cutaneous lesions for acid-fast staining and cultures, and molecular probe assays to detect the presence of mycobacterial pathogens 5.
Treatment and Management
- The treatment of cutaneous mycobacterial infections, including those caused by Mycobacterium abscessus, is species-specific and often requires a combination of different antimicrobial agents 5, 6.
- Individualized susceptibility testing is not recommended for most nontuberculous mycobacterial infections, except for some species, and in case of therapeutic failure 6.
- Severe cases or those with deep tissues involvement may also require surgical resection 6.