AN OUTBREAK OF NON TUBERCULOUS MYCOBACTERIA IN POST SURGICAL WOUND INFECTION IN A TERTIARY CARE CENTRE IN WESTERN UTTAR PRADESH

Dr Ruchi Kotpal, Dr. Neetika Agarwal, Dr. Savita Yadav

Abstract


Purpose – Non tuberculous mycobacteria (NTM) are environmental organisms that can cause skin and soft tissue
infections at incision site in patients undergoing surgical procedures. Most of the NTM causing these infections are not
treated by rst line standard anti tubercular drugs.
Methods – it is a case series of 30 patients who presented to our hospital with nodular swelling followed by discharging sinus at the site of incision
almost one month after they underwent surgery all over the period of 6 month from May to October 2018,. Pus was collected and examined for
isolation and identication of the causative agents. Debrided sinus tract was also sent for histopathological examination.
Result - Of the 30 patients examined, all presented with discharging sinus, with no systemic symptoms, none of them responded to pyogenic
antibiotics. None of the pus sample was positive for gram staining and all were sterile for pyogenic culture, 60% positivity for ZN staining, 80% grew
Mycobacteria on LJ media and 100% showed granulomatous inammation on histopathology. All responded to oral clarithromycin for 4-6 weeks
Conclusion - Present study indicate that non-tuberculous mycobacterial infections should be considered in wounds that show delayed healing,
do not respond to antibiotics used for pyogenic infections and have sterile aerobic cultures. Empirical therapy should be initiated immediately.
Also smear positivity and culture positivity are not the sole criteria for considering mycobacterial infections.


Keywords


post surgical, wound infections, Non tuberculous mycobacteria (NTM), discharging sinus

Full Text:

PDF

References


Kazda JF. The principles of ecology of mycobacteria. In: Stanford JL, Ratledge C, editors. Biology of Mycobacteria. Academic Press1983; 2:323-42.

Peters M, Muller C, Rusch-Gerdes S, Seidel C, Gobel U, Pohle HD, Ruf B. Isolation of atypical mycobacteria from tap water in hospitals and homes: is this a possible source of disseminated MAC infection in AIDS patients. J Infect 1995; 31:39–44.

Glover N, Holtzman A, Aronson T, Froman S, Berlin O G W, Dominguez P ,et al. The isolation and identification of Mycobacterium avium complex (MAC) recovered from Los Angeles potable water, a possible source of infection in AIDS patients. Int J Environ Health Res 1994; 4:63–72.

Phillips MS, Reyn CF. Nosocomial Infections Due to Nontuberculous Mycobacteria. Clinical Infectious Diseases 2001; 33:1363–74.

Veena Kumari HB, Nagarathna S, Chandramouli BA, Umamaheshwara Rao GS, Chandramukhi A. Investigation of an outbreak of device-related postoperative ventriculitis: a lesson learnt. Indian J Pathol Microbiol 2008; 51(2):301–3.

Sethi NK, Aggarwal PK, Duggal L, Sachar VP. Mycobacterium chelonae infection following laparoscopic inguinal herniorrhaphy. JAPI 2003;51:81-2.

Col Lahiri KK, Brig Jena J, Lt Col Pannicker KK. Mycobacterium fortuitum Infections in Surgical Wounds. MJAFI 2009; 65 : 91-2.

Set R, Rokade S, Agrawal S, Shastri J. Antimicrobial susceptibility testing of rapidly growing mycobacteria by microdilution - Experience of a tertiary care centre Ind J Med Microbiol 2010; 28:48-50.

Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, Von Reyn CF, Wallace RJ, Winthrop K. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. American J of Resp and Critical Care Med 2007;175(4): 367-416.

Woods RK, Dellinger EP. Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 1998;57(11):2731–40.

Wahed AM, Al-Gassab A, Al-Jaffar LY, Tinguria M, Al-Meer ZS, Borgio F. Atypical mycobacteria: an unusual cause of breast abscess. Ann of Saudi Med 1997; 17(3): 337-9

Falkinham OJ III. Epidemiology of infections by nontuberculous mycobacteria. Clin Microbiol Rev 1996;9(2):177–215

Chaudhuri S, Sarkar D, Mukerji R. Diagnosis and Management of Atypical Mycobacterial Infection after Laparoscopic Surgery. Indian J Surg 2010;72(6):438–42.

Vijayaraghavan R, Chandrashekhar R, Sujatha Y, Belagavi CS. Hospital outbreak of atypical mycobacterial infection of port sites after laparoscopic surgery. J Hosp Infect 2006;64:344-7.

Kalita JB, Rahman H and Baruah KC. Delayed post-operative wound infections due to non-tuberculous Mycobacterium. Indian J Med Res 2005;22:535-9.

Kwon YH, Lee GY, Kim WS, Kim KJ. A Case of Skin and Soft Tissue Infection Caused by Mycobacterium abscessus. Ann Dermatol 2009;21:84-7.

Rajini M, Prasad SR, Reddy RR, Bhat RV, Vimala KR. Postoperative infection of laparoscopic surgery wound due to Mycobacterium chelonae. Ind J Med Microbiol 2007;25(2):163-5

Rodrigues C, Mehta A, Jha U, Bharucha M, Dastur FD, Udwadia TE. Nosocomical Mycobacterium chelonae infection in laparoscopic surgery. Infect Control Hosp Epidemiol 2001;22:474–5.


Refbacks

  • There are currently no refbacks.