Treating Primary Arthroprosthesis Infection Caused by Mycobacterium abscessus subsp. abscessus

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Microbiology

Background:

• Prosthetic joint infections (PJI) caused by nontuberculous mycobacteria are exceptionally rare.
• This case involves a 72-year-old female with a hip replacement experiencing a PJI.

Observation:

• The patient developed PJI caused by Mycobacterium abscessus subsp. abscessus six months post-surgery.
• The isolate exhibited clarithromycin resistance and harbored the erm(41) gene.
• Treatment involved a two-stage reimplantation with a 3-month course of amikacin, imipenem, and clarithromycin, followed by an additional 7 months of medical therapy.

Findings:

• The patient successfully recovered with a well-positioned prosthesis and normal inflammatory markers after treatment.
• Microbiologic investigations were negative at the time of reimplantation.
• The patient experienced significant side effects from tigecycline.

Implications:

• Mycobacterium abscessus subsp. abscessus should be considered in the differential diagnosis of PJI, particularly with negative routine cultures.
• Further research is needed to correlate in vitro susceptibility testing with clinical outcomes for M. abscessus PJI.
• Optimal surgical timing and duration of medical therapy for M. abscessus PJI require further investigation.