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Gu Y, Nie W, Huang H, Yu X. Non-tuberculous mycobacterial disease: progress and advances in the development of novel candidate and repurposed drugs. Front Cell Infect Microbiol 2023; 13:1243457. [PMID: 37850054 PMCID: PMC10577331 DOI: 10.3389/fcimb.2023.1243457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are opportunistic pathogens that can infect all body tissues and organs. In particular, the lungs are the most commonly involved organ, with NTM pulmonary diseases causing serious health issues in patients with underlying lung disease. Moreover, NTM infections have been steadily increasing worldwide in recent years. NTM are also naturally resistant to many antibiotics, specifically anti-tuberculosis (anti-TB) drugs. The lack of drugs targeting NTM infections and the increasing drug resistance of NTM have further made treating these mycobacterial diseases extremely difficult. The currently recommended NTM treatments rely on the extended indications of existing drugs, which underlines the difficulties of new antibiotic discovery against NTM. Another challenge is determining which drug combinations are most effective against NTM infection. To a certain extent, anti-NTM drug development depends on using already available antibiotics and compounds. Here, we aimed to review new antibiotics or compounds with good antibacterial activity against NTM, focusing on their mechanisms of action, in vitro and in vivo antibacterial activities.
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Affiliation(s)
- Yuzhen Gu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-Resistant Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Wenjuan Nie
- Tuberculosis Department, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-Resistant Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory on Drug-Resistant Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
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2
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Yanagihara T, Kawamura T, Minagi K, Sekine Y, Sugai K, Ichimura H, Sato Y. Successful long-term management for postoperative sternal infection with multiple disseminated lymphadenitis caused by Mycobacterium abscessus. Surg Case Rep 2023; 9:146. [PMID: 37599318 PMCID: PMC10440305 DOI: 10.1186/s40792-023-01730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Postoperative sternal infection caused by Mycobacterium abscessus (M. abscessus) is rare, but associated with a high 2-year mortality rate of 40%. Decision-making around treatment strategy is challenging. Here, we present a successfully treated case of postoperative M. abscessus sternal infection with multiple disseminated lymphadenitis. CASE PRESENTATION The patient, an 80-year-old woman with anterior mediastinal tumor and myasthenia gravis, underwent extended thymectomy under median sternotomy. Redness appeared around the scar two months after the operation. Sternal wires were removed, debridement was performed, and the wound was kept open. Mycobacterium abscessus was isolated from the wound culture. The disseminated lesions in the right axillary, parasternal, and bilateral supraclavicular lymph nodes, rendered surgical options for infection control difficult; therefore, she was treated conservatively with antibiotics and negative pressure wound therapy (NPWT). The wound diminished but infectious granulation tissue remained after NPWT. Two disseminated lesions were percutaneously punctured and drained of pus, which resulted in negative cultures. Additional debridement and wound closure were performed. She was discharged after switching to oral antibiotics. No recurrence was observed five months after the antibiotics were completed (total sensitive antibiotics use: 366 days). CONCLUSIONS Repeated culture assessment of disseminated lesions is recommended to facilitate the development of appropriate therapeutic strategies. Localized procedures may be an option for patients with controlled disseminated lesions evidenced by negative cultures.
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Affiliation(s)
- Takahiro Yanagihara
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
| | - Kenji Minagi
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
| | - Yasuharu Sekine
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
| | - Kazuto Sugai
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
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Waletzko B, Lin PL, Lopez SMC. "Hot Tub Lung" With M. avium complex in an Immunocompetent Adolescent. Pediatr Infect Dis J 2023; 42:e84-e87. [PMID: 36729986 DOI: 10.1097/inf.0000000000003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a case of pulmonary Mycobacterium avium complex (MAC) infection in an immunocompetent pediatric patient after a hot tub near drowning event with a literature review of pediatric MAC-associated disease after hot tub exposure.
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Affiliation(s)
- Benjamin Waletzko
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Santiago M C Lopez
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota
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Affiliation(s)
| | | | - David L Goldman
- Department of Pediatrics and Microbiology and Immunology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
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5
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Nakamura Y, Yoshioka D, Miyagawa S, Yoshikawa Y, Hata H, Nakae M, Toda K, Sawa Y. A case of Mycobacterium chelonae mediastinitis and acute humoral rejection after heart transplantation. J Card Surg 2019; 34:205-207. [PMID: 30816595 DOI: 10.1111/jocs.13997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/05/2019] [Indexed: 11/29/2022]
Abstract
Mediastinitis is one of the life-threating complications that can occur after cardiac surgery. However, to the best of our knowledge, there has been no report of mediastinitis caused by Mycobacterium chelonae, which is one of the rapidly growing nontuberculous mycobacteria species. As far as we know, our case is the first case describing the curative management for mediastinitis caused by M. chelonae after heart transplantation.
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Affiliation(s)
- Yuki Nakamura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masaro Nakae
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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6
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Epidemiologic Review of Veterans Health Administration Patients with Isolation of Nontuberculous Mycobacteria after Cardiopulmonary Bypass Procedures. Infect Control Hosp Epidemiol 2017; 38:1103-1106. [DOI: 10.1017/ice.2017.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated the isolation of postoperative nontuberculous mycobacteria (NTM) associated with heater-cooler devices (HCDs) used during cardiopulmonary bypass (CPB) surgery in the Veterans Health Administration from January 1, 2010, to December 31, 2016. In more than 38,000 CPB procedures, NTM was isolated in 111 patients; 1 Mycobacterium chimaera mediastinitis case and 1 respiratory isolate were found.Infect Control Hosp Epidemiol 2017;38:1103–1106
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Mycobacterium infection from a cardiopulmonary bypass heater-cooler unit in a patient with steroid-induced immunosuppression. Can J Anaesth 2016; 64:513-516. [DOI: 10.1007/s12630-016-0809-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022] Open
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Chand M, Lamagni T, Kranzer K, Hedge J, Moore G, Parks S, Collins S, Del Ojo Elias C, Ahmed N, Brown T, Smith EG, Hoffman P, Kirwan P, Mason B, Smith-Palmer A, Veal P, Lalor MK, Bennett A, Walker J, Yeap A, Isidro Carrion Martin A, Dolan G, Bhatt S, Skingsley A, Charlett A, Pearce D, Russell K, Kendall S, Klein AA, Robins S, Schelenz S, Newsholme W, Thomas S, Collyns T, Davies E, McMenamin J, Doherty L, Peto TEA, Crook D, Zambon M, Phin N. Insidious Risk of Severe Mycobacterium chimaera Infection in Cardiac Surgery Patients. Clin Infect Dis 2016; 64:335-342. [PMID: 27927870 DOI: 10.1093/cid/ciw754] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/14/2016] [Accepted: 11/11/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands. METHODS Parallel investigations were pursued: (1) identification of cardiopulmonary bypass-associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates. RESULTS Eighteen probable cases of cardiopulmonary bypass-associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81-87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases. CONCLUSIONS We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.
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Affiliation(s)
- Meera Chand
- National Infection Service, Public Health England.,Guy's and St Thomas' NHS Foundation Trust, and.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London
| | | | | | - Jessica Hedge
- Nuffield Department of Medicine, University of Oxford
| | - Ginny Moore
- National Infection Service, Public Health England
| | - Simon Parks
- National Infection Service, Public Health England
| | | | | | - Nada Ahmed
- National Infection Service, Public Health England
| | - Tim Brown
- National Infection Service, Public Health England
| | - E Grace Smith
- National Infection Service, Public Health England.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London
| | | | - Peter Kirwan
- National Infection Service, Public Health England
| | | | | | - Philip Veal
- Health Protection Service, Public Health Agency Northern Ireland, Belfast, United Kingdom
| | | | | | - James Walker
- National Infection Service, Public Health England
| | - Alicia Yeap
- National Infection Service, Public Health England
| | - Antonio Isidro Carrion Martin
- National Infection Service, Public Health England.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Gayle Dolan
- National Infection Service, Public Health England.,Field Epidemiology Service, Public Health England, Newcastle
| | - Sonia Bhatt
- National Infection Service, Public Health England
| | | | | | - David Pearce
- National Infection Service, Public Health England
| | | | - Simon Kendall
- South Tees Hospitals Foundation NHS Trust, Middlesbrough.,Society for Cardiothoracic Surgery in Great Britain and Ireland, London
| | - Andrew A Klein
- Papworth Hospital NHS Foundation Trust, Cambridge.,Association of Cardiothoracic Anaesthetists, London
| | | | - Silke Schelenz
- Royal Brompton and Harefield NHS Foundation Trust, London
| | | | - Stephanie Thomas
- University Hospital South Manchester NHS Foundation Trust, Manchester
| | - Tim Collyns
- Leeds Teaching Hospitals NHS Trust, Leeds, and
| | - Eleri Davies
- Public Health Wales NHS Trust, Cardiff.,Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Jim McMenamin
- Vaccine Preventable Diseases, Health Protection Scotland, Glasgow, and
| | - Lorraine Doherty
- Health Protection Service, Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford
| | - Derrick Crook
- National Infection Service, Public Health England.,Nuffield Department of Medicine, University of Oxford
| | - Maria Zambon
- National Infection Service, Public Health England.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London
| | - Nick Phin
- National Infection Service, Public Health England
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Kurt T, Vural A, Temiz A, Ozbudak E, Yener AU, Sacar S, Sacar M. Adjunctive Hyperbaric Oxygen Therapy or Alone Antibiotherapy? Methicillin Resistant Staphylococcus aureus Mediastinitis in a Rat Model. Braz J Cardiovasc Surg 2016; 30:538-43. [PMID: 26735600 PMCID: PMC4690658 DOI: 10.5935/1678-9741.20150055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/02/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In the post-sternotomy mediastinitis patients, Staphylococcus aureus is the pathogenic microorganism encountered most often. In our study, we aimed to determine the efficacy of antibiotic treatment with vancomycin and tigecycline, alone or in combination with hyperbaric oxygen treatment, on bacterial elimination in experimental S. aureus mediastinitis. METHODS Forty-nine adult female Wistar rats were used. They were randomly divided into seven groups, as follows: non-contaminated, contaminated control, vancomycin, tigecycline, hyperbaric oxygen, hyperbaric oxygen + vancomycin and hyperbaric oxygen + tigecycline. The vancomycin rat group received 10 mg/kg/day of vancomycin twice a day through intramuscular injection. The tigecycline group rats received 7 mg/kg/day of tigecycline twice a day through intraperitoneal injection. The hyperbaric oxygen group underwent 90 min sessions of 100% oxygen at 2.5 atm pressure. Treatment continued for 7 days. Twelve hours after the end of treatment, tissue samples were obtained from the upper part of the sternum for bacterial count assessment. RESULTS When the quantitative bacterial counts of the untreated contaminated group were compared with those of the treated groups, a significant decrease was observed. However, comparing the antibiotic groups with the same antibiotic combined with hyperbaric oxygen, there was a significant reduction in microorganisms identified (P<0.05). Comparing hyperbaric oxygen used alone with the vancomycin and tigecycline groups, it was seen that the effect was not significant (P<0.05). CONCLUSION We believe that the combination of hyperbaric oxygen with antibiotics had a significant effect on mediastinitis resulting from methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus mediastinitis can be treated without requiring a multidrug combination, thereby reducing the medication dose and concomitantly decreasing the side effects.
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Affiliation(s)
- Tolga Kurt
- Department of Cardiovascular Surgery, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Vural
- Department of Microbiology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ersan Ozbudak
- Department of Cardiovascular Surgery, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ali Umit Yener
- Department of Cardiovascular Surgery, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Suzan Sacar
- Department of Infectious Disease and Clinical Microbiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Mustafa Sacar
- Department of Cardiovascular Surgery, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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10
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Abstract
Sternal mycobacterial infections are rare. Due to the rarity, its clinical characteristics, diagnoses, and regular management strategies are still scanty. A total of 76 articles on this topic were obtained by a comprehensive literature collection. The clinical features, diagnosis, management strategies and prognosis were carefully analyzed. There were totally 159 patients including 152 (95%) cases of tuberculosis (TB) and seven (5%) cases of non-TB sternal infections. Sternal mycobacterial infections can be categorized into three types: Primary, secondary, and postoperative, according to the pathogenesis; and categorized into isolated, peristernal, and multifocal, according to the extent of the lesions. Microbiological investigation is more sensitive than medical imaging and Mantoux tuberculin skin test in the diagnosis of sternal infections. Most patients show good responses to the standard four-drug regimen and a surgical intervention was necessary in 28.3% patients. The prognoses of the patients are good with a very low mortality. A delayed diagnosis of sternal mycobacterial infections may bring about recurrent sternal infections and sustained incurability. An early diagnosis and prompt antibiotic regimens may significantly improve the patients' outcomes.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China
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11
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Yuan SM. Sternal wound tuberculosis following cardiac operations: a review. Braz J Cardiovasc Surg 2016; 30:489-93. [PMID: 27163424 PMCID: PMC4614933 DOI: 10.5935/1678-9741.20140102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022] Open
Abstract
Objective The diagnosis and treatment of sternal wound infections with mycobacteria are
challenging. Such an infection is often associated with a delayed diagnosis
and improper treatment that may lead to a worsened clinical outcome. The
present study is designed to highlight its clinical features so as to
facilitate a prompt diagnosis and timely treatment. Methods MEDLINE, Highwire Press, and Google search engine were searched for
publications in the English language, with no time limit, reporting on
sternal wound infection caused by tuberculosis after cardiac surgery. Results A total of 12 articles reporting on 14 patients were included in this study.
Coronary artery bypass grafting was the underlying surgical procedure in
more than half of the cases. Purulent discharge and cold abscess were the
two main presenting symptoms. Diagnosis of sternal wound infection was
evidenced in all 14 patients by different investigations, with culture of
samples being the most sensitive method of identifying the pathogen. Good
response to first-line anti-tuberculous agents was noted. Almost all
patients required surgical debridement/resection and, sometimes, sternal
reconstruction. A delayed diagnosis of sternal wound infection may lead to
repeated recurrences. A comparison between patients with sternal wound
infection due to tuberculosis and non-tuberculous mycobacterial infections
showed that the former infections took an even longer period of time.
Comparisons also revealed patients with sternal tuberculosis infection had a
significantly higher mortality than patients with sternal non-tuberculous
infection (29.2% vs. 0%, P=0.051). Conclusion Sternal infection caused by tuberculosis after cardiac surgery has a longer
latency, better response to first-line drugs, and better outcomes in
comparison with non-tuberculous sternal infection. Early diagnosis and early
anti-tuberculous treatment can surely improve the patients' prognosis.
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Affiliation(s)
- Shi-Min Yuan
- Teaching Hospital, Fujian Medical University, Putian, China
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12
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Recurrent pocket infection due to Mycobacterium chelonae at the site of an explanted cardiac implantable electrical device in proximity to a long-standing tattoo. HeartRhythm Case Rep 2016; 2:132-134. [PMID: 27014568 PMCID: PMC4785634 DOI: 10.1016/j.hrcr.2015.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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