Yeh Jui-Po, Tsai Yueh-Ju
From the Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Ann Plast Surg. 2023 Apr 1;90(1 Suppl 1):S55-S59. doi: 10.1097/SAP.0000000000003345. Epub 2022 Dec 21.
Nontuberculosis mycobacteria (NTM) commonly occur in nature. Although the infection rate is low, soft tissue infection with NTM after surgical procedures is possible in both immunocompromised and normal populations. For cosmetic surgery, NTM infection has emerged as a common infection in the recent years, and this indicates the need to pay more attention, especially to those with prolonged atypical uncertain wound problems.
We aimed to report a case of NTM infection after breast augmentation to share our experience on clinical appearance and process of diagnosis and treatment, and to review the existing literature.
We retrospectively review a patient who suffered from NTM infection after liposuction and fat grafting for breast augmentation between 2019 and 2021 in our hospital. The baseline characteristics, operations, bacterial culture report, medications, and outpatient information were collected from medical records.
The patient suffered from purulent skin lesions after breast augmentation and was diagnosed with NTM infection according to the culture report. The NTM infection was resolved after a long-term course of treatment for around a year, including surgical debridement, serial aspirations, and prescriptions of antituberculosis medications.
The results of our study suggest that NTM must be considered when facing refractory infections after surgeries or invasive procedures without bacterial growth on routine cultures. Acid-fast stain and mycobacterial culture are strongly recommended. Treatment modalities include localized aspiration, surgical debridement, and multidrug antibiotics based on the sensitivity of the microorganism.
非结核分枝杆菌(NTM)在自然界中普遍存在。尽管感染率较低,但在免疫功能低下和正常人群中,手术后发生NTM软组织感染均有可能。对于整形手术而言,NTM感染近年来已成为一种常见感染,这表明需要更加关注,尤其是那些存在长期非典型不确定伤口问题的患者。
我们旨在报告一例隆胸术后NTM感染病例,分享我们在临床表现以及诊断和治疗过程方面的经验,并对现有文献进行综述。
我们回顾性分析了2019年至2021年期间在我院因抽脂和脂肪移植隆胸术后发生NTM感染的一名患者。从病历中收集了基线特征、手术情况、细菌培养报告、用药情况及门诊信息。
该患者隆胸术后出现脓性皮肤病变,根据培养报告诊断为NTM感染。经过约一年的长期治疗,包括手术清创、多次抽吸以及抗结核药物处方,NTM感染得以治愈。
我们的研究结果表明,面对手术后或侵入性操作后常规培养无细菌生长的难治性感染时,必须考虑NTM感染。强烈建议进行抗酸染色和分枝杆菌培养。治疗方式包括局部抽吸、手术清创以及根据微生物敏感性使用多种抗生素。