Challenges in Treating Mycobacterium chelonae/abscessus Prosthetic Joint Infection. (June 2022)

• Record Type: Journal Article
• Authors: Singh, Divita; Johnson, Mikayla; Kitchens, Caleah S.; Boone, Andrew
• Is Part Of: Journal of pharmacy practice. Volume 35:Number 3(2022)
• Page Start: 492
• Page End: 494
• Publication Date: 2022-06
• Subjects: prosthetic joint infections -- rapidly growing mycobacterium -- Mycobacterium chelonae -- Mycobacterium abscessus; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/0897190020977757
• Languages: English
• ISSNs: 0897-1900

Abstract

Prosthetic joint infections (PJIs) remain a major complication of arthroplasty, most of which are caused by Staphylococcus aureus and gram-negative bacteria. Unfortunately, cultures are false negative in upward of 7 percent of patients with suspected PJIs, and commonly in infections caused by rare rapidly growing mycobacterium (RGM) species. Guidelines recommend 6 months of antimycobacterial therapy for bone diseases caused by RGM, with empiric therapy consists of an oral macrolide (clarithromycin or azithromycin) plus tobramycin and imipenem-cilastatin. Definitive treatment of PJI due to RGM should be guided by antimicrobial susceptibility, however, most microbiology laboratories are unable to differentiate between M. chelonae and M. abscessus . Furthermore, treatment of M. chelonae PJI is challenging due to multidrug resistance and the dearth of oral antibiotics for therapy. This case report investigates a patient with PJI caused by M. chelonae and M. abscessus . The initial treatment with imipenem-cilastatin was complicated by drug induced seizures, further limiting therapy options.