Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures

Abstract

Background The early diagnosis and treatment of skin and soft tissue infections caused by nontuberculous mycobacteria (NTM) are important, especially as infections with rapidly growing mycobacteria (RGM) are rare and difficult to diagnose and treat. Recently, we identified 22 cases of NTM infections; in this study, we suggest treatment strategies by analyzing the demographic characteristics and treatment progress of these patients. Methods A retrospective study of patients with NTM infections from 2009 to 2019 was conducted. To identify NTM infections, acid-fast bacillus (AFB) staining, Gram staining, polymerase chain reaction (PCR), and cultures of mycobacteria were performed. Empirical treatment with a combination of antibiotics or surgery was performed; species identification and drug susceptibility tests were performed by the Korean National Tuberculosis Association. The final regimen was determined after obtaining the test results. Results The mean incubation time of NTM was 4.32±2.88 weeks. RGM were detected in mycobacterial cultures in 21 of the 22 NTM patients. The results of AFB staining were negative in all patients, although PCR was positive for NTM in one patient. Fourteen patients were hospitalized for treatment with intravenous antibiotics and surgery. Treatment with a combined regimen of oral antibiotics was maintained for a mean of 5.41±1.85 months. Conclusions The unusual clinical manifestations of skin and soft tissue infections caused by NTM make them difficult to diagnose. Suspicion of NTM based on clinical presentation and a detailed examination should be followed by proper treatment involving multiple antibiotics and surgery in these patients.