INTRODUCTION: Sternal wound infection caused by Mycobacterium chelonae, a member of the rapidly growing nontuberculous mycobacteria (NTM), is rare and may present without signs and symptoms of systemic infection. METHODS: We present a patient who had a M. chelonae infection of the sternum following excision of a left atrial myxoma and conducted a review of the literature from 1976 to 2013. RESULTS: Seventy cases of NTM sternal wound infection after cardiac surgery were identified, including six outbreaks and ten sporadic cases including the present case. Thirty-four cases were isolated coronary artery bypass grafting (CABG) surgery, 16 cases were isolated valve replacement, and two cases were valve replacement with CABG. The age range of the patients was between 6 and 78 years. The average time from the surgery was 49 ± 58 days which was longer than the usual bacterial mediastinitis. The overall mortality rate was 29%. CONCLUSION: NTM sternal wound infection is rare but may be fatal if not properly treated. The toxic signs are often subtle and it will take longer to isolate compared to typical bacterial mediastinitis. Early recognition, the use of appropriate antibiotics based on susceptibility tests, and aggressive surgical debridement are required for full recovery.
INTRODUCTION: Sternal wound infection caused by Mycobacterium chelonae, a member of the rapidly growing nontuberculous mycobacteria (NTM), is rare and may present without signs and symptoms of systemic infection. METHODS: We present a patient who had a M. chelonaeinfection of the sternum following excision of a left atrial myxoma and conducted a review of the literature from 1976 to 2013. RESULTS: Seventy cases of NTM sternal wound infection after cardiac surgery were identified, including six outbreaks and ten sporadic cases including the present case. Thirty-four cases were isolated coronary artery bypass grafting (CABG) surgery, 16 cases were isolated valve replacement, and two cases were valve replacement with CABG. The age range of the patients was between 6 and 78 years. The average time from the surgery was 49 ± 58 days which was longer than the usual bacterial mediastinitis. The overall mortality rate was 29%. CONCLUSION: NTM sternal wound infection is rare but may be fatal if not properly treated. The toxic signs are often subtle and it will take longer to isolate compared to typical bacterial mediastinitis. Early recognition, the use of appropriate antibiotics based on susceptibility tests, and aggressive surgical debridement are required for full recovery.
Authors: Meera Chand; Theresa Lamagni; Katharina Kranzer; Jessica Hedge; Ginny Moore; Simon Parks; Samuel Collins; Carlos Del Ojo Elias; Nada Ahmed; Tim Brown; E Grace Smith; Peter Hoffman; Peter Kirwan; Brendan Mason; Alison Smith-Palmer; Philip Veal; Maeve K Lalor; Allan Bennett; James Walker; Alicia Yeap; Antonio Isidro Carrion Martin; Gayle Dolan; Sonia Bhatt; Andrew Skingsley; André Charlett; David Pearce; Katherine Russell; Simon Kendall; Andrew A Klein; Stephen Robins; Silke Schelenz; William Newsholme; Stephanie Thomas; Tim Collyns; Eleri Davies; Jim McMenamin; Lorraine Doherty; Tim E A Peto; Derrick Crook; Maria Zambon; Nick Phin Journal: Clin Infect Dis Date: 2016-12-07 Impact factor: 20.999