Empirical treatment of highly suspected nontuberculous mycobacteria infections following aesthetic procedures

Hyung Rok Kim, Eul Sik Yoon, Deok-Woo Kim, Na Hyun Hwang, Yoo Seok Shon, Byung-Il Lee, Seung Ha Park

Research output: Contribution to journalArticle

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Abstract

Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

Original languageEnglish
Pages (from-to)759-767
Number of pages9
JournalArchives of Plastic Surgery
Volume41
Issue number6
DOIs
Publication statusPublished - 2014 Nov 1

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Nontuberculous Mycobacterium Infections
Esthetics
Nontuberculous Mycobacteria
Clarithromycin
Therapeutics
Stenotrophomonas
Infection
Surgical Wound Infection
Skin
Soft Tissue Infections
Pigmentation
Debridement
Granuloma
Cicatrix
Differential Diagnosis

Keywords

  • Antibiotics
  • antitubercular
  • Early diagnosis
  • Mycobacterium infections nontuberculous
  • Soft-tissue infections

ASJC Scopus subject areas

  • Surgery

Cite this

Empirical treatment of highly suspected nontuberculous mycobacteria infections following aesthetic procedures. / Kim, Hyung Rok; Yoon, Eul Sik; Kim, Deok-Woo; Hwang, Na Hyun; Shon, Yoo Seok; Lee, Byung-Il; Park, Seung Ha.

In: Archives of Plastic Surgery, Vol. 41, No. 6, 01.11.2014, p. 759-767.

Research output: Contribution to journalArticle

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