Challenges in Treating Mycobacterium chelonae/abscessus Prosthetic Joint Infection

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Microbiology

Background:

• Prosthetic joint infections (PJIs) are a significant complication of arthroplasty.
• Staphylococcus aureus and gram-negative bacteria are common causative agents.
• Rare rapidly growing mycobacteria (RGM) can also cause PJIs, often with false-negative cultures.

Observation:

• Guidelines recommend 6 months of antimycobacterial therapy for RGM bone diseases.
• Empiric therapy includes macrolides, tobramycin, and imipenem-cilastatin.
• Microbiology labs struggle to differentiate M. chelonae and M. abscessus, complicating definitive treatment.

Findings:

• This case report details a PJI caused by both M. chelonae and M. abscessus.
• Initial treatment with imipenem-cilastatin led to drug-induced seizures, limiting therapeutic choices.
• Mycobacterium chelonae PJI presents challenges due to multidrug resistance and a lack of oral antibiotics.

Implications:

• Accurate diagnostics are crucial for effective RGM PJI management.
• Novel therapeutic strategies are needed to address multidrug-resistant RGM.
• Further research into differentiating and treating M. chelonae and M. abscessus PJIs is warranted.