Infection of a venous port - beware of the Mycobacterium
Tseng Hui Heng1, Marcus Hin Yeung Loh1, Ying Ying Chua2
1Singapore General Hospital, Department of Vascular and Interventional Radiology, Singapore.
Abstract:
An 84-year-old female with metastatic left breast cancer underwent a venous port insertion for chemotherapy. The port was inserted using standard techniques with image guidance under local anesthesia. She presented after 36 days with evidence of infection. A limited bedside ultrasound demonstrated free fluid surrounding the port. The port was subsequently removed the same day, at which time pus was expressed from the subcutaneous pocket. The culture from the pus grew Mycobacterium abscessus. She required removal of the port and wound debridement, wound dressings and a prolonged course of antibiotics. Mycobacterium abscessus is a group of rapidly growing, multidrug-resistant, non-tuberculous mycobacteria that are also relatively resistant to standard skin disinfectants. In recent years, this organism has been increasingly reported as the culprit in post-operative or post-procedural infections. Treatment is challenging due to multidrug resistance, and requires an extensive course of intravenous antimicrobial and macrolide-based combination therapy followed by oral antimicrobial therapy. Early treatment is essential as progression may result in disseminated infection. We discuss the peri-operative and post-operative care required in preventing and treating infection with this organism.
Insights
A patient developed a rare Mycobacterium abscessus infection after a venous port insertion for breast cancer treatment. Prompt port removal and antibiotics were crucial to manage this challenging multidrug-resistant organism.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Oncology Nursing
Background:
- Central venous access devices (CVADs) are essential for chemotherapy delivery in metastatic breast cancer patients.
- Port insertion, while standard, carries a risk of infection, necessitating vigilant monitoring.
- Mycobacterium abscessus poses a unique challenge due to its resistance profile.
Observation:
- An 84-year-old female with metastatic breast cancer developed a port-associated infection 36 days post-insertion.
- Bedside ultrasound revealed perip-ort fluid; subsequent removal yielded pus positive for Mycobacterium abscessus.
- The patient required port removal, debridement, and prolonged antibiotic therapy.
Findings:
- Mycobacterium abscessus, a rapidly growing, multidrug-resistant non-tuberculous mycobacterium, was identified as the causative agent.
- This organism demonstrates resistance to standard skin disinfectants, complicating prevention and treatment.
- Treatment necessitates a complex regimen of intravenous and oral antibiotics, often macrolide-based.
Implications:
- Early recognition and management of Mycobacterium abscessus infections are critical to prevent disseminated disease.
- Enhanced peri-operative and post-operative care protocols are needed to mitigate risks associated with this pathogen.
- Multidrug resistance in Mycobacterium abscessus highlights the need for novel therapeutic strategies and improved infection control measures.
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