Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose-shi, Tokyo, 204-8533, Japan.
BMC Infect Dis. 2023 Oct 17;23(1):694. doi: 10.1186/s12879-023-08702-1.
Mycobacterium abscessus subsp. massiliense (MMA) comprises a group of non-tuberculous, rapidly growing mycobacteria. Although MMA can cause pulmonary diseases, surgical site infections, and disseminated diseases, aortic endograft infection has not been reported. Here, we describe the first case of aortic endograft infection caused by MMA.
Two months after stent-graft insertion for an abdominal aortic aneurysm, an 85-year-old man was admitted with fever and abdominal pain and was diagnosed with aortic endograft infection. Despite 14 days of meropenem and vancomycin intravenous administration, periaortic fluid pooling increased as compared to that before antibiotic administration. The abscess was drained, and fluorescent acid-fast staining of the abscess fluid revealed bacilli. We conducted genetic tests on the genes hsp65, rpoB, and sodA, performed Whole Genome Sequencing (WGS), and identified the organism as MMA. Intravenous imipenem-cilastatin (IPM/CS), amikacin (AMK), and oral clarithromycin (CAM) were administered. After 2 months, oral CAM and sitafloxacin were administered because the abscess had decreased in size. However, after 6 weeks, the abscess increased in size again. Antimicrobial susceptibility testing of the drainage fluid from the abscess resulted in the isolation of an MMA strain that had acquired resistance to CAM. Intravenous IPM/CS, AMK, and oral linezolid were added to the treatment regimen along with oral CAM and STFX. However, he was not fully cured and died 6 months later. Neither the full-length erythromycin ribosome methyltransferase (erm)(41) gene nor the rrl or rpIV gene mutations were found by Sanger sequencing in the pre- and post-treatment strains. Whole-genome sequence analysis of the post-treatment strain revealed mutations in genes with no previous reports of association with macrolide resistance.
Aortic endograft infection caused by MMA strain is extremely rare; nonetheless, MMA should be suspected as the causative microorganism when broad-spectrum antimicrobials are ineffective.
脓肿分枝杆菌亚种（MMA）是一组非结核、快速生长的分枝杆菌。虽然 MMA 可引起肺部疾病、手术部位感染和播散性疾病，但主动脉移植物感染尚未见报道。在这里，我们描述了首例由 MMA 引起的主动脉移植物感染病例。
一名 85 岁男性在腹主动脉瘤支架置入术后 2 个月因发热和腹痛入院，被诊断为主动脉移植物感染。尽管静脉使用美罗培南和万古霉素 14 天，但与抗生素使用前相比，周围脓肿积液增多。脓肿被引流，脓肿液的荧光抗酸染色显示杆菌。我们对 hsp65、rpoB 和 sodA 基因进行了基因检测，进行了全基因组测序（WGS），并鉴定出该病原体为 MMA。静脉注射亚胺培南-西司他丁（IPM/CS）、阿米卡星（AMK）和口服克拉霉素（CAM）。2 个月后，由于脓肿体积减小，开始口服 CAM 和司他氟沙星。然而，6 周后，脓肿再次增大。脓肿引流液的药敏试验导致分离出对 CAM 耐药的 MMA 株。在治疗方案中加入静脉注射 IPM/CS、AMK 和口服利奈唑胺，同时口服 CAM 和 STFX。然而，他并未完全治愈，6 个月后死亡。在治疗前后的菌株中，通过 Sanger 测序均未发现完整的红霉素核糖体甲基转移酶（erm）（41）基因或 rrl 或 rpIV 基因突变。对治疗后菌株的全基因组序列分析显示，在以前与大环内酯类耐药无关的基因中存在突变。
由 MMA 株引起的主动脉移植物感染极为罕见；然而，当广谱抗生素无效时，应怀疑 MMA 为致病微生物。
