Delayed Port-Site Infections Caused by Nontuberculous Mycobacteria after Laparoscopic Procedures: Experience from a Tertiary Hospital in North India
,
Abstract
Background: Port-site infections caused by nontuberculous mycobacteria (NTM) following laparoscopic surgery represent a rare yet increasingly recognized complication in modern surgical practice. These infections, driven by environmental pathogens resistant to standard sterilization methods, pose significant diagnostic and therapeutic challenges due to their insidious onset and resistance to conventional treatments.
Methods: This retrospective study examined 20 patients who developed infection between May 2024 and August 2024, collecting data on demographics, clinical presentations, latency periods, diagnostic outcomes, and treatment results.
Results: The cohort, with a mean age of 36.5 years (range: 8-70) and 60% female predominance, most commonly presented with pus discharge (70%), with a median latency period of 39 days from surgery to symptom onset. Diagnostic efforts revealed excisional biopsy as the most effective method, yielding a 25% positivity rate, far surpassing pus swabs and aspirations at 5% each. Treatment involved prolonged combination antibiotic therapy—macrolides paired with linezolid or amikacin—resulting in complete resolution in all cases with no recurrences within a 6-month follow-up.
Conclusion: These findings underscore the necessity of heightened clinical suspicion, advanced diagnostic techniques, and adherence to extended treatment protocols to manage NTM infections effectively, offering critical insights into their prevention and management in laparoscopic surgery settings.
2. Loureiro CA, Ramos J, Martins R, et al. A decade of minimally invasive surgery. Ann Surg 2017; 265(4):670-5.
3. Claridge JA, Swartz B, Mace JL, et al. Postoperative infections in minimally invasive surgery. Surg Endosc 2001; 15(3):366-72.
4. Wright GP, Koenig S, Jones M, et al. Gastric band–associated NTM infections. BMC Infect Dis 2014; 14:40.
5. Yoon SH, Lee J, Kim K, et al. Biofilm formation by rapidly growing mycobacteria. Microbiol 2015; 161(7):1418-26.
6. Honda H, Yamane N. Mycobacteria in water systems. Appl Environ Microbiol 2005; 71(8):4931-9.
7. Montecalvo MA, Jarvis WR. Pseudomonas and mycobacteria contamination in endoscopy. Gastrointest Endosc 2002; 56(7):953-7.
8. Vijayaraghavan R, Sahni AK, Sharma S, et al. Hospital outbreak of atypical mycobacterial infection. J Hosp Infect 2006; 64(4):344-7.
9. Shah M, Dheda K. Nontuberculous mycobacterial infections in surgical settings: a systematic review. J Clin Tuberc Other Mycobact Dis 2017; 8:1-8.
10. Wong SY, Yeoh DK, Grimwood K, et al. Outbreaks of M. fortuitum: lessons learned. Infect Control Hosp Epidemiol 2016; 37(5):622-8.
11. Sasmal PK, Ghosh SK, Mitra S, et al. Port-site infection in laparoscopic surgery: a review of its management. World J Clin Cases 2015; 3(10):864-71.
12. Chopra S, Mahajan M, Dutta R, et al. Rapid detection of NTM by PCR. J Med Microbiol 2016; 65(8):740-8.
13. Griffith DE, Aksamit T, Brown-Elliott BA, et al. ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367-416.
14. Brown-Elliott BA, Wallace RJ Jr, Tichindelean C, et al. Clinical and laboratory features of rapidly growing mycobacteria. Clin Microbiol Rev 2006; 19(2):216-40.
15. Yasmin S, Sharma M, Deshmukh M, et al. Comparative efficacy of macrolides against NTM. J Antimicrob Chemother 2015; 70(8):2175-83.
16. Gantry SL, Hudson AO. Linezolid efficacy in rapidly growing mycobacteria. Antimicrob Agents Chemother 2011; 55(8):3889-98.
17. Wallace RJ, Meier A, Brown BA, et al. Macrolide resistance in M. abscessus. Antimicrob Agents Chemother 2011; 55(1):402-9.
18. Koh WJ, Jeong BH, Kim SY, et al. Treatment outcomes of M. abscessus pulmonary disease. Am J Respir Crit Care Med 2011; 183(9):1207-14.
19. Lyu J, Kim BJ, Kim JH, et al. Role of linezolid in M. abscessus therapy. Antimicrob Agents Chemother 2021; 65(2):e01890-20.
20. Daley CL, Iaccarino JM, Lange C, et al. ATS/ERS/ESCMID/IDSA clinical practice guideline: Treatment of NTM. Eur Respir J 2020; 56(1):2000535.
21. Shahrizaila N, Azman Y, Zulkifli SZ, et al. Mycobacterium fortuitum infection after abdominal surgery. Singapore Med J 2010; 51(6):e115-8.
22. Marks MI, Thomas N, Wilson M, et al. Treatment adherence in long-term NTM therapy. Chest 2020; 158(4):1468-78.
23. van Ingen J, Boeree MJ, Dekhuijzen PNR, et al. Emerging resistance in M. abscessus. J Antimicrob Chemother 2018; 73(1):316-20.
24. Johnson MM, Odell JA, Aksamit TR, et al. NTM treatment guidelines: Update 2021. Am J Respir Crit Care Med 2021; 204(9):e103-20.
25. Lande L, Wallace RJ, Brown-Elliott BA, et al. Diagnostic yield of AFB smear in NTM infections. J Clin Microbiol 2020; 58(1):e01715-19.
26. Banerjee A, Kundu M, Chakrabarti P, et al. Protocols for mycobacterial culture. J Clin Pathol 2008; 61(9):1021-5.
27. Mascarenhas J, D’Souza D, Singh A, et al. PCR-based rapid diagnosis of NTM. Diagn Microbiol Infect Dis 2018; 91(3):254-9.
28. Primm TP, Lucero CA, Falkinham JO. Health impacts of environmental mycobacteria. Clin Microbiol Rev 2004; 17(1):98-106.
29. Lee MR, Sheng WH, Hung CC, et al. Epidemiology and clinical features of nontuberculous mycobacteria in ventilator-associated pneumonia. Clin Infect Dis 2014; 59(5):711-7.
30. Sohal JS, Sharma M, Virdi JS, et al. Rapid growers in abdominal surgery. J Surg Res 2019; 243:419-27.
31. Yim JH, Park SY, Lee SH, et al. Atypical mycobacterial port-site infections: case series. Surg Infect (Larchmt). 2013; 14(1):238.
32. Rutala WA, Weber DJ. Guidelines for disinfection and sterilization. Infect Control Hosp Epidemiol 2008; 2(59 Suppl 1):S1-79.
33. Alfa MJ, Olson N, Buelow-Smith L, et al. Efficacy of high-level disinfectants against NTM. Am J Infect Control 2013; 41(4):304-7.
34. Somerville W, Tschetter L, Carr R, et al. Disinfectant resistance in NTM. Appl Environ Microbiol 2014; 80(24):7585-92.
35. Tortoli E. Multiplex PCR for NTM identification. J Clin Microbiol 2010; 48(4):1208-12.
36. Misener RM, Patel D, Krueger S, et al. Environmental surveillance for NTM in hospitals. J Hosp Infect 2017; 95(3):358-65.
37. Rivera-Ortega P, Binks M, Baker L, et al. NTM in endoscopic equipment. Gastrointest Endosc 2017; 85(5):1016-23.
38. Bashir G, Ahmed T, Jan A, et al. Colorimetric assays as the diagnostic modality of pulmonary and extra-pulmonary tuberculosis in resource-limited settings. JoMMID 2022; 12(03):108-15.
| Issue | Vol 13 No 3 (2025) | |
| Section | Original Articles | |
| Keywords | ||
| Antimicrobial therapy Hospital acquired infection Laparoscopy Mycobacterial infection Surgical wound infection. | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
