Kim Hyung Rok, Yoon Eul Sik, Kim Deok Woo, Hwang Na Hyun, Shon Yoo Seok, Lee Byung Il, Park Seung-Ha
Department of Plastic Surgery and Reconstructive Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2014 Nov;41(6):759-67. doi: 10.5999/aps.2014.41.6.759. Epub 2014 Nov 3.
Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen.
A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement.
All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients.
NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.
非结核分枝杆菌（NTM）引起的感染一直在增加。认识这种感染至关重要，但也存在问题。治疗延迟可能导致破坏性后果。在病原体鉴定之前，我们对一系列临床怀疑NTM感染的患者进行了经验性治疗。
回顾了2011年1月至2014年2月期间发生手术部位感染的12例患者。皮肤和皮下感染对标准治疗两周以上无效且在三个月内有美容手术史的患者被高度怀疑患有NTM感染。同时检查了多种诊断方法，并开始经验性治疗，包括克拉霉素和莫西沙星联合使用以及手术清创。
所有伤口在4周内完全愈合。平均随访时间为7.2个月，所有患者均未复发。6例患者鉴定出特定的NTM病原体。8例患者出现干酪样肉芽肿，提示NTM感染。1例患者出现罕见的嗜麦芽窄食单胞菌感染，已成功治疗。3例患者尽管反复进行微生物检测仍无病原体证据。所有患者均常见瘢痕形成、色素沉着和毁容等并发症。
在不寻常的皮肤和软组织感染的鉴别诊断中应考虑NTM。我们提出克拉霉素和莫西沙星的经验性方案作为NTM感染的有效治疗选择。
