From the Guidelines
Surgical wound infections caused by nontuberculous mycobacteria (NTM) are a significant concern, and treatment should be initiated promptly with a combination of antimicrobial therapy and surgical intervention, as recommended by the American Journal of Respiratory and Critical Care Medicine 1. The clinical presentation of NTM surgical wound infections can vary, but common symptoms include localized drainage or abscess formation at the site of the wound, delayed wound healing, persistent drainage, or wound dehiscence weeks to months after surgery.
- The most common NTM species responsible for surgical wound infections are M. fortuitum, M. abscessus, and M. chelonae, which are often associated with nosocomial skin and soft tissue infections 1.
- Diagnosis is made by culture of the specific pathogen from drainage material or tissue biopsy, with tissue biopsy being the most sensitive means of obtaining a specimen for culture 1.
- Treatment regimens typically include a combination of antimicrobial agents such as clarithromycin, ethambutol, and rifampin, with treatment duration ranging from 3-6 months for rapidly growing mycobacteria to 6-12 months for slower-growing species.
- Surgical debridement is crucial to remove infected tissue and biofilms that protect bacteria from antibiotics, and wound cultures should specifically request mycobacterial testing, as NTM won't grow on routine bacterial cultures 1.
- It is essential to note that NTM infections often result from contaminated water or solutions used during surgery, inadequate sterilization of surgical instruments, or environmental contamination, highlighting the need for strict infection control measures in healthcare settings.
From the Research
Causes of Surgical Wound Infection
- Surgical wound infections can be caused by various pathogens, including non-tuberculous mycobacteria (NTM) 2
- NTM infections in post-operative wounds are rare, but should be suspected in cases where the infection occurs late, lacks local and systemic signs of pyogenic infections, and has sterile cultures 2
Characteristics of NTM Infections
- NTM infections can manifest as discharging sinuses between 2-3 weeks after surgery 2
- The most common NTM organism isolated is M. fortuitum (57%) 2
- NTM infections can be treated with long-term antimicrobial therapy, with a mean duration of treatment of 6 to 9 months 2
Treatment of NTM Infections
- Prolonged treatment with combinations of antibiotics is effective in treating NTM diseases, with surgery as an important complementary tool 3
- The recommended duration of therapy for skin and soft-tissue infection is usually 2-4 months for mild disease and 6 months for severe disease 3
- Treatment of musculoskeletal NTM disease usually requires at least 6-12 months 3
Prevention of Surgical Wound Infections
- Keeping patients normothermic can reduce the risk of surgical wound infection threefold 4
- Providing supplemental oxygen during surgery and for the initial hours after surgery can reduce the risk of infection by an additional factor of two 4
- Avoidance of perioperative factors that increase the incidence of wound infection, as well as the appropriate use of perioperative antibiotic prophylaxis, can decrease the incidence of wound infection 5