Successful addition of topical antibiotic treatment after surgery in treatment-refractory nontuberculous mycobacterial skin and soft tissue infections

Mycobacterium heraklionense hand tenosynovitis-a case description of a three-year treatment course and perioperative measurement of azithromycin target tissue concentrations

In a Mycobacterium heraklionense tenosynovitis case, we observed that azithromycin-loaded calcium sulfate beads placed in the surgical wound had minimal systemic absorption and achieved over 100-fold higher target tissue concentrations than a systemic azithromycin-based treatment regimen alone. However, continued excessive wound drainage necessitated surgical removal of the beads. While systemic antibiotics and surgery remain central to nontuberculous mycobacterial treatment, the role of local antibiotic administration in reducing the bacterial burden warrants further investigation.

Application of surgical management combined with photodynamic therapy in the treatment of nontuberculous mycobacterial infections after cosmetic surgery

BACKGROUND

In recent years, the number of patients with nontuberculous mycobacteria (NTM) infections caused by invasive procedures such as cosmetic surgery has been increasing. However, treating NTM infections presents significant challenges, with no standardized diagnostic or treatment guidelines currently available.

METHODS

This study included 10 patients diagnosed with skin and soft tissue NTM infections following cosmetic surgery. Each patient underwent surgical treatment, followed by Photodynamic therapy (PDT) after debridement. PDT was performed using topical 20 % 5-aminolevulinic acid (ALA, 2 mL: 10 mg) applied to the wound periphery (2 cm margin), followed by a 3-hour incubation under light occlusion and activation with a 635 nm diode laser at an energy density of 120 J/cm². Exposure durations were dynamically adjusted (20-40 min) based on real-time pain tolerance. Weekly PDT sessions were administered, with total treatment duration individualized according to wound healing progression. Post-procedural pain was assessed using the Facial Expression Pain Scale (FEPS) and managed through a tiered protocol: ice compression for mild-to-moderate pain (FEPS 2-4) and NSAIDs/opioids for severe pain (FEPS >4). Antibiotics were selected based on the results of drug susceptibility testing.

RESULTS

All ten patients achieved clinical cure, with a notable reduction in the duration of therapy. All patients were followed for over six months without recurrence of infection. Post-PDT pain was universally in all patients, with FEPS scores ranging from 2 to 7, and managed effectively by the final treatment. Transient adverse events included erythema (n = 10) and pruritus (n = 2), resolving spontaneously within 48 h. No chronic complications were observed.

CONCLUSION

The combination of surgical intervention and PDT, along with appropriate antibiotic therapy, may be a safe and effective approach for treating skin and soft tissue NTM infections after cosmetic surgery.

Effects of aminolevulinic acid photodynamic therapy combined with antibiotics on Mycobacterium abscessus skin infections: An in vitro and in vivo study

BACKGROUND

Mycobacterium abscessus skin infections have emerged as a major medical issue. Traditional antibiotic treatments are challenging, prolonged, and often lead to recurrence, creating an urgent need for new therapies. This study investigates the effectiveness of aminolevulinic acid photodynamic therapy (ALA-PDT) combined with antibiotics in treatmenting M. abscessus, using both in vitro and in vivo methods.

METHODS

We treated eight patients with M. abscessus skin infections following cosmetic surgery, using ALA-PDT (ALA concentration: 20 %; red light: 80 J/cm2) combined with oral or intravenous antibiotics,including clarithromycin, moxifloxacin and amikacin, to treat 8 patients with M. abscessus skin infection after medical cosmetic surgery, and assessed the treatment outcomes. Additionally, four bacterial strains (MAB-A1, MAB-A2, MAB-B1, and MAB-B2) isolated from patients were tested in vitro for ALA-PDT efficacy to determine the optimal ALA-PDT dosage. Furthermore, the strains' single colony morphology, biofilm formation, and genome characteristics of were analyzed to explore the factors influencing ALA-PDT's bactericidal effects. Finally, a combined ALA-PDT and antibiotics sterilization experiment was conducted in vitro.

RESULTS

Clinically, ALA-PDT combined with antibiotics showed strong efficacy in treating M. abscessus skin infections, with no recurrence observed during follow-up. In vitro, ALA-PDT effectively killed M. abscessus, although MAB-B1 and MAB-B2 required a higher ALA-PDT dose compared with MAB-A1 and MAB-A2. Compared to MAB-A1 and MAB-A2, MAB-B1 and MAB-B2 exhibited stronger biofilm formation capabilities and bacterial virulence as well as genome mutations primarily affecting fatty acid synthesis and metabolism, potentially explaining their increased ALA-PDT dosage requirement. Notably, the combination of ALA-PDT and antibiotics exerted markedly higher bactericidal effects in vitro compared with antibiotics alone.

CONCLUSIONS

ALA-PDT combined with antibiotics emerged as an effective treatment for M. abscessus skin infections. However, optimal dosage and antibiotic combinations should be tailored to the characteristics of specific clinical strains.

Metagenomic next-generation sequencing may assist diagnosis of osteomyelitis caused by Mycobacterium houstonense: A case report

BACKGROUND

Mycobacterium houstonense (M. houstonense) belongs to the nontuberculous mycobacterium group. Infection caused by M. houstonense is prone to recurrence.

CASE SUMMARY

We present a patient who was diagnosed with osteomyelitis caused by M. houstonense and treated with a combination of cefoxitin, and amikacin combined with linezolid.

CONCLUSION

The emergence of metagenomic next-generation sequencing (NGS) has brought new hope for the diagnosis and treatment of listeria meningitis. NGS can analyze a large number of nucleic acid sequences in a short time and quickly determine the pathogen species in the sample. Compared with traditional cerebrospinal fluid culture, NGS can greatly shorten the diagnosis time and provide strong support for the timely treatment of patients. Regarding treatment, NGS can also play an important role. Rapid and accurate diagnosis can enable patients to start targeted treatment as soon as possible and improve the treatment effect. At the same time, by monitoring the changes in pathogen resistance, the treatment plan can be adjusted in time to avoid treatment failure.

Emerging and alternative strategies for the treatment of nontuberculous mycobacterial infections

INTRODUCTION

Nontuberculous mycobacteria (NTM) infections have emerged as a significant clinical challenge due to their intrinsic multidrug resistance and the limited efficacy of existing treatments. These infections are becoming increasingly prevalent, with a need for new and effective therapeutic strategies.

AREAS COVERED

This review addresses several key aspects of NTM infections: i) pathogenesis and epidemiology; ii) the limitations and challenges of current treatment options; iii) emerging and alternative therapeutic strategies; iv) advanced drug delivery systems such as nanoparticles and efflux pump inhibitors; v) innovative antibacterial alternatives like antimicrobial peptides, bacteriophage therapy, and phytochemicals; and vi) other potential treatment modalities such as inhaled nitric oxide, small molecules, surgical debridement, phototherapy, and immunomodulatory therapy.

EXPERT OPINION

Personalized medicine, advanced drug delivery systems, and alternative therapies hold promise for the future of NTM treatment. Early and accurate identification of NTM species, enabled by improved diagnostic methods, is critical for tailoring treatment regimens. Emerging therapies show promise against drug-resistant NTM strains, but overcoming barriers like clinical trials, regulatory hurdles, and high production costs is crucial. Continued research and innovation are essential to improve treatment efficacy and patient outcomes.

Case Commentary: Another prong of attack? Topical antibiotic instillation with negative pressure wound therapy for nontuberculous mycobacterial skin and soft tissue infections

Nontuberculous mycobacteria (NTM) skin infections remain therapeutically challenging. Given the diversity in infections, host responses, and antimicrobials, clinical guidelines are often built on case series and observational studies. In this commentary, we respond to a paper by Stemkens et al. that introduces an emerging strategy: adjunctive negative pressure wound therapy with instillation and dwell time combined with topical antibiotics for refractory NTM skin and soft tissue infections. We delve into the primary considerations surrounding this innovative approach.