Ghosh Roumi, Das Soumen, De Asmita, Kela Harish, Saha Makhan Lal, Maiti Prasanta Kumar
Department of Microbiology, ESI-PGIMSR and ESIC Medical College, Kolkata, West Bengal, India.
Department of General Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
Int J Mycobacteriol. 2017 Jan-Mar;6(1):34-37. doi: 10.4103/2212-5531.201901.
Port-site infection (PSI) is a prevailing, chronic, nagging, treatment refractory complication of laparoscopic surgery (LS). It neutralizes the advantages of minimally invasive surgery and increases morbidity, treatment cost of patient, leading to loss of confidence on operating surgeon. PSIs are preventable with appropriate preoperative, intraoperative, and postoperative measures. Atypical mycobacterium is most commonly associated with nonhealing postlaparoscopic wound infections, causing outbreaks or sporadic cases worldwide.
We retrospectively studied the occurrence of nontuberculous mycobacterium (NTM) from PSIs following LS that did not respond to antibiotics used for pyogenic infections and having sterile routine aerobic cultures and their antimicrobial susceptibility pattern to guide proper management.
The study was done in a tertiary care hospital of Eastern India over a 1-year period which included PSI cases with delayed onset not responding to antibiotics, following different types of LS. Pus/discharge from 32 patients was collected and examined for isolation and identification of the causative agents. Gram stain and Ziehl-Neelsen staining methods were used for direct examination. Culture media included blood agar, Robertson's cooked meat broth, MacConkey agar, and Lowenstein-Jensen medium. Isolates from the cases were identified using biochemical tests or molecular methods and studied the antimicrobial susceptibility pattern by the standard microbiologic procedures.
Mycobacterium abscessus (13) and Mycobacterium fortuitum (2) were isolated from 15 serosanguinous drainage obtained from 32 cases by routine microbiological techniques. All isolates analyzed for antimicrobial susceptibility pattern were highly sensitive to clarithromycin (93.3%), amikacin (93.3%), and imipenem (80%) but were variable to ciprofloxacin, ofloxacin, and linezolid.
Our present study shows frequent association of NTM with laparoscopic port-site nonhealing chronic infection or wound dehiscence. Although direct microscopy can give us a clue to diagnosis, culture isolation is required for speciation and antimicrobial susceptibility testing, which helps formulate therapeutic regimen.
切口感染是腹腔镜手术（LS）常见的、慢性的、棘手的、治疗难治性并发症。它抵消了微创手术的优势，增加了患者的发病率和治疗成本，导致患者对手术医生失去信心。通过适当的术前、术中和术后措施，切口感染是可预防的。非典型分枝杆菌最常与腹腔镜术后伤口不愈合感染相关，在全球范围内引起暴发或散发病例。
我们回顾性研究了腹腔镜手术后切口感染中对用于化脓性感染的抗生素无反应且常规需氧培养无菌的非结核分枝杆菌（NTM）的发生情况及其抗菌药敏模式，以指导正确的管理。
该研究在印度东部的一家三级护理医院进行，为期1年，纳入了不同类型腹腔镜手术后切口感染且抗生素治疗延迟起效的病例。收集了32例患者的脓液/分泌物，进行病原体的分离和鉴定。采用革兰氏染色和齐-尼氏染色方法进行直接检查。培养基包括血琼脂、罗伯逊熟肉培养基、麦康凯琼脂和罗-琴培养基。通过生化试验或分子方法对病例分离株进行鉴定，并采用标准微生物学程序研究其抗菌药敏模式。
通过常规微生物技术从32例患者的15份血性引流液中分离出脓肿分枝杆菌（13株）和偶发分枝杆菌（2株）。所有分析抗菌药敏模式的分离株对克拉霉素（93.3%）、阿米卡星（93.3%）和亚胺培南（80%）高度敏感，但对环丙沙星、氧氟沙星和利奈唑胺的敏感性各不相同。
我们目前的研究表明NTM与腹腔镜切口不愈合慢性感染或伤口裂开频繁相关。虽然直接显微镜检查可为诊断提供线索，但需要进行培养分离以进行菌种鉴定和抗菌药敏试验，这有助于制定治疗方案。
