Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
BMC Infect Dis. 2019 Apr 23;19(1):333. doi: 10.1186/s12879-019-3979-2.
Historically Mycobacterium houstonense belongs to the unnamed third biovariant complex of the Mycobacterium fortuitum group, which are sorbitol positive. To date, there have been few reports of human infection induced by M. houstonense worldwide.
We describe the case of a 68-year-old man with surgical wound infection, following an open humeral fracture, caused by M. houstonense and Escherichia coli. An implant bone plate had been embedded for internal fixation during surgery on the humeral fracture previously. A week later E. coli was isolated from the skin wound secretions. Cefoperazone-sulbactam was used for treatment for two weeks but the infection was not controlled, with a subsequent risk of deep wound infection. External fixation of the fracture was then performed instead of internal fixation. Ten days later, M. houstonense was isolated from new wound secretions. M. houstonense was identified by the molecular sequencing method. The TREK Diagnostic System was used to test the susceptibility to antibiotics by the microbroth dilution method. Levofloxacin and amikacin were used for treatment according to the results of the susceptibility test and the patient's condition obviously improved.
To the best of our knowledge, this is the first case in China of human surgical wound infection caused by M. houstonense following open humeral fracture. The combination of levofloxacin and amikacin was effective in the treatment of M. houstonense infection.
历史上，休斯顿分枝杆菌属于莫拉氏菌属中未命名的第三生物变异群，该群为山梨醇阳性。迄今为止，全世界关于人感染休斯顿分枝杆菌的报道很少。
我们描述了一例 68 岁男性患者，在肱骨开放性骨折手术后发生手术部位感染，感染由休斯顿分枝杆菌和大肠埃希菌引起。此前，在肱骨骨折手术中内置了植入式骨板进行内固定。一周后，从皮肤伤口分泌物中分离出大肠埃希菌。使用头孢哌酮-舒巴坦治疗两周，但感染未得到控制，随后存在深部伤口感染的风险。随后，对骨折进行了外部固定，而不是内固定。10 天后，从新的伤口分泌物中分离出休斯顿分枝杆菌。采用分子测序法鉴定出休斯顿分枝杆菌。采用微量肉汤稀释法，使用 TREK 诊断系统检测抗生素敏感性。根据药敏试验结果和患者病情，使用左氧氟沙星和阿米卡星进行治疗，患者病情明显改善。
据我们所知，这是中国首例开放性肱骨骨折后由休斯顿分枝杆菌引起的人手术部位感染。左氧氟沙星和阿米卡星联合使用对休斯顿分枝杆菌感染有效。
