A Persistent Problem: Mycobacterium abscessus Infection of an Orthopedic Device after Trauma

Surgical site infection of orthopedic trauma patients is common and tends to be treated with optimal therapy after an organism is identified from intraoperative cultures. However, delayed presentation and multidrug resistance can lead to complications. In our case, we investigate a delayed presentation of Mycobacterium abscessus orthopedic hardware infection in a patient with a forearm fracture secondary to a motor vehicle accident. Six weeks after stabilization of the fracture, purulence from an iliac crest bone graft donor site was noted. Further investigation led to the diagnosis of M. abscessus infection of both the graft donor and recipient sites in the forearm. After a multitude of surgeries, including orthopedic hardware removal from the forearm, and concurrent antibiotic therapy of amikacin, imipenem, tedizolid, and omadacycline, the patient was deemed medically cleared of her infection. Rapid-growing nontuberculous mycobacterium (RGNTM) are rare infections of trauma patients that warrant further clinical investigation into best management practices. This has implications for both civilian and military battlefield-related trauma infections. This case serves as an example of successful multi-disciplinary management through appropriately aggressive surgery and tailored antibiotic therapy.