García-Ruza Miriam, Blanco Juan, Campusano Katherine, Silva Douglas, Claro Franklin, de Waard Jacobus H
From the Department of Plastic, Reconstructive, Aesthetic, and Maxillofacial Surgery. Hospital Vargas de Caracas, San José, Caracas, Venezuela.
Departamento de Tuberculosis y Micobacteriosis, Servicio Autónomo Instituto de Biomedicina "Dr. Jacinto Convit, Hospital Vargas de Caracas, San José, Caracas, Venezuela.
Plast Reconstr Surg Glob Open. 2024 Oct 24;12(10):e6254. doi: 10.1097/GOX.0000000000006254. eCollection 2024 Oct.
Nontuberculous mycobacteria (NTM) infections after cosmetic surgery have become an increasing concern. These infections are often initially misdiagnosed and treated with standard antibiotic regimens, which fail to resolve the underlying infection, leading to prolonged patient suffering. In this case study, we describe a chronic wound infection caused by subsp. after a muscle-repair abdominoplasty. This case illustrates the diagnostic and therapeutic challenges plastic surgeons face in successfully treating such infections. Initial obstacles included the isolation of co-contaminating bacteria that masked the NTM infection, the use of antibiotics ineffective against the specific NTM species, and the failure to identify the infection source. In this instance, contaminated skin marker ink used to mark the rectus muscle, combined with a nonabsorbable (permanent) suture for muscle repair, led to the development of a biofilm that acted as a persistent reservoir for the infection, resistant to antibiotic treatments. Complete resolution was achieved only after evaluation by a plastic surgeon experienced in treating NTM infections and the subsequent removal of the permanent suture. The delayed suture removal contributed to a 15-month recovery period. This case underscores the importance of early recognition of NTM infections after cosmetic procedures. By sharing this case, we aim to raise awareness of NTM infections and help prevent future cases of misdiagnosis and prolonged antibiotic treatments. Key points regarding the diagnosis, sources of infection, and treatment options for NTM infections are highlighted in this article using "text boxes" to emphasize the most important information and provide concise summaries of critical insights.
整形手术后非结核分枝杆菌（NTM）感染已日益引起关注。这些感染最初常被误诊，并采用标准抗生素方案治疗，而这无法解决潜在感染问题，导致患者长期受苦。在本病例研究中，我们描述了一例腹直肌修复腹壁成形术后由 亚种引起的慢性伤口感染。该病例说明了整形外科医生在成功治疗此类感染时面临的诊断和治疗挑战。最初的障碍包括分离出掩盖NTM感染的共污染细菌、使用对特定NTM菌种无效的抗生素以及未能识别感染源。在此病例中，用于标记腹直肌的受污染皮肤标记墨水，加上用于肌肉修复的不可吸收（永久性）缝线，导致形成生物膜，成为感染的持续储存库，对抗生素治疗具有抗性。仅在由治疗NTM感染经验丰富的整形外科医生进行评估并随后拆除永久性缝线后才实现完全治愈。缝线拆除延迟导致恢复期长达15个月。该病例强调了整形手术后早期识别NTM感染的重要性。通过分享此病例，我们旨在提高对NTM感染的认识，并帮助预防未来的误诊和长期抗生素治疗病例。本文使用“文本框”突出显示了关于NTM感染的诊断、感染源和治疗选择的关键点，以强调最重要的信息并提供关键见解的简明摘要。
