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JB & JS Open Access 2023Although infection following anterior cruciate ligament (ACL) reconstruction is rare, these cases have potentially catastrophic ramifications. Nontuberculous...
UNLABELLED
Although infection following anterior cruciate ligament (ACL) reconstruction is rare, these cases have potentially catastrophic ramifications. Nontuberculous mycobacteria (NTM) are ubiquitous, located in the water supply and soil. Our objective was to review the literature to characterize NTM infection following ACL reconstruction.
METHODS
A database search was performed for arthroscopic ACL reconstructions that resulted in a postoperative diagnosis of NTM infection.
RESULTS
The literature search returned 6 case reports that met the inclusion criteria. The initial postoperative presentation occurred after 3 to 52 weeks, which is consistent with reports of postoperative NTM infection.
CONCLUSIONS
The common indolent course of NTM infection hinders prompt diagnosis and treatment. Organism susceptibility testing is crucial for effective treatment and limiting unnecessary antibiotic exposure.
CLINICAL RELEVANCE
The duration of medical treatment for NTM infection is 4 to 6 months, depending on the severity of disease and species. Based on the aggregate literature, we recommend removal of local implants if the infection is localized and without articular involvement. However, in cases of articular involvement, all fixation and graft material should be removed.
PubMed: 37123505
DOI: 10.2106/JBJS.OA.23.00030 -
Clinical Microbiology and Infection :... Aug 2023Since 2013, heater-cooler unit (HCU) associated Mycobacterium chimaera infections linked to a global outbreak have been described. These infections were characterised by... (Meta-Analysis)
Meta-Analysis Review
Clinical characteristics and outcome of Mycobacterium chimaera infections after cardiac surgery: systematic review and meta-analysis of 180 heater-cooler unit-associated cases.
OBJECTIVES
Since 2013, heater-cooler unit (HCU) associated Mycobacterium chimaera infections linked to a global outbreak have been described. These infections were characterised by high morbidity and mortality due to delayed diagnosis, as well as challenges in antimycobacterial and surgical therapy. This study aimed to investigate the clinical characteristics and outcome of published cases of HCU-associated M. chimaera infections.
METHODS
We searched PubMed and the Web of Science until 15 June 2022 for case reports, case series, and cohort studies, without language restriction, on patients with M. chimaera infection and a prior history of cardiac surgery. In this systematic review of case reports, no risk of bias assessment could be performed. Clinical, microbiological, and radiological features were recorded. Logistic regression and time-to-event analyses were performed to identify the potential factors associated with better survival.
RESULTS
One hundred eighty patients from 54 publications were included. Most patients underwent surgical aortic valve (67.0%; 118/176 of patients with available data) or combined aortic valve and root replacement (15.3%; 27/176). The median period between the time point of surgery and the first symptoms was 17 months (interquartile range 13-26 months). The overall case fatality rate was 45.5% (80/176), with a median survival of 24 months after the initiation of antimycobacterial therapy or diagnosis. A reoperation (including the removal or exchange of foreign material) was associated with better survival in multivariate logistic regression (OR 0.32 for lethal events; 95% CI 0.12-0.79; p 0.015) and in time-to-event analysis (p 0.0094).
DISCUSSION
This systematic review and meta-analysis confirm the high overall mortality of HCU -associated disseminated M. chimaera infections after cardiac surgery. A reoperation seems to be associated with better survival. Physicians have to stay aware of this infection, as patients might still be present today due to the long latency period.
Topics: Humans; Mycobacterium Infections; Mycobacterium; Cardiac Surgical Procedures; Mycobacterium avium Complex; Equipment Contamination; Mycobacterium Infections, Nontuberculous
PubMed: 36918144
DOI: 10.1016/j.cmi.2023.03.005 -
Internal Medicine Journal Dec 2023Antimicrobial resistance and therapy-related adverse effects make Mycobacterium abscessus treatment challenging. Omadacycline is a novel, bioavailable aminomethylcycline...
BACKGROUND
Antimicrobial resistance and therapy-related adverse effects make Mycobacterium abscessus treatment challenging. Omadacycline is a novel, bioavailable aminomethylcycline with favourable in vitro activity against M. abscessus.
AIMS
To describe a case report and review the published literature describing outcomes for M. abscessus infections treated with omadacycline.
METHODS
Systematic literature review.
RESULTS
We identified three articles that, in addition to our case report, describe 18 patients. Pulmonary infections were most frequent. Minimum inhibitory concentrations were reported for two isolates (0.25 and 0.5 mg/L). Despite half the patients starting omadacycline because of failure of prior therapy, 15 (83%) had a favourable outcome, defined as 'cure', 'improvement' or 'clinical success' as determined by the primary study authors. One patient (6%) discontinued omadacycline because of gastrointestinal intolerance.
CONCLUSIONS
Although the limited observational data and in vitro susceptibility results are encouraging, randomised control trials are required to determine the role of omadacycline as part of combination therapy for this most difficult-to-treat pathogen.
Topics: Humans; Anti-Bacterial Agents; Mycobacterium abscessus; Tetracyclines; Mycobacterium Infections, Nontuberculous; Microbial Sensitivity Tests
PubMed: 36917124
DOI: 10.1111/imj.16071 -
One Health (Amsterdam, Netherlands) Jun 2023() disease is an important infection disease throughout the world. () is a common . Extrapulmonary infections due to , particularly spine infections, are a rare...
BACKGROUND AND PURPOSE
() disease is an important infection disease throughout the world. () is a common . Extrapulmonary infections due to , particularly spine infections, are a rare occurrence, but lack of research is cited as a constraint for implementing control in such patients. The purposes of this paper are to describe a case of spondylodiscitis, to review the published literature on cases of spine infections, and to summarize the predisposing factors, diagnosis, and treatment of infection.
METHODS
A case of spondylodiscitis was caused by in a patient with systemic lupus erythematosus (SLE). Research was conducted using the PubMed, ScienceDirect, Embase, Wiley Online Library, and Scopus databases using the following search terms: "", "vertebral", "spinal", "spondylodiscitis", "infection", and "osteomyelitis".
RESULTS
We retrieved 14 cases published before August 2022. The risk factors for infection were iatrogenic infections (3/14, 21.43%), SLE (4/14, 28.57%), AIDS (4/14, 28.57%), and immunocompetence without any comorbidities (3/14, 21.43%). The most common sites of infection were thoracic vertebrae (10/14, 71.43%) and lumbar vertebrae (4/14, 28.57%). A total of 14 cases were isolated and identified as from a toad by mycobacterial culture. The identification time was 55.00 ± 7.55 days (the present report identification time of metagenomic next generation sequencing (mNGS) was only 2 days). All patients were treated with antibiotic therapy, and the duration of treatment was 13.18 ± 2.13 months. Clarithromycin-based therapy showed a higher improvement rate (5/6, 83.33%). Surgical intervention was performed in 5 patients. Only 1 patient did not show any improvement after surgical treatment.
CONCLUSION
spine infection in humans presents with atypical clinical symptoms. mNGS identification may be a good choice. may be considered in immunocompromised patients with spinal infection. We recommend a clarithromycin-containing regimen and prolonging the duration of treatment to ensure effectiveness.
PubMed: 36817979
DOI: 10.1016/j.onehlt.2023.100502 -
ERJ Open Research Jan 2023People living with cystic fibrosis have an increased risk of lung infection with nontuberculous mycobacteria (NTM), the prevalence of which is reportedly increasing. We... (Review)
Review
BACKGROUND
People living with cystic fibrosis have an increased risk of lung infection with nontuberculous mycobacteria (NTM), the prevalence of which is reportedly increasing. We conducted a systematic review of the literature to estimate the burden (prevalence and incidence) of NTM in the cystic fibrosis population.
METHODS
Electronic databases, registries and grey literature sources were searched for cohort and cross-sectional studies reporting epidemiological measures (incidence and prevalence) of NTM infection or NTM pulmonary disease in cystic fibrosis. The last search was conducted in September 2021; we included reports published since database creation and registry reports published since 2010. The methodological quality of studies was appraised with the Joanna Briggs Institute tool. A random effects meta-analysis was conducted to summarise the prevalence of NTM infection, and the remaining results are presented in a narrative synthesis.
RESULTS
This review included 95 studies. All 95 studies reported on NTM infection, and 14 of these also reported on NTM pulmonary disease. The pooled estimate for the point prevalence of NTM infection was 7.9% (95% CI 5.1-12.0%). In meta-regression, sample size and geographical location of the study modified the estimate. Longitudinal analysis of registry reports showed an increasing trend in NTM infection prevalence between 2010 and 2019.
CONCLUSIONS
The overall prevalence of NTM infection in cystic fibrosis is 7.9% and is increasing over time based on international registry reports. Future studies should report screening frequency, microbial identification methods and incidence rates of progression from NTM infection to pulmonary disease.
PubMed: 36605902
DOI: 10.1183/23120541.00336-2022 -
PloS One 2022The prevalence of Mycobacterium avium complex (MAC) is increasing globally. Macrolide-based multidrug regimens have been recommended as the first-line treatment for...
INTRODUCTION
The prevalence of Mycobacterium avium complex (MAC) is increasing globally. Macrolide-based multidrug regimens have been recommended as the first-line treatment for patients with MAC pulmonary disease. However, developing macrolide resistance was associated with poor treatment outcomes and increased mortality. In 2018, the U.S. Food and Drug Administration approved liposomal amikacin for inhalation (LAI) to treat refractory MAC pulmonary disease. The current systematic review aimed to evaluate LAI's outcomes and adverse events in MAC pulmonary disease.
METHODS
The systematic search was performed in PubMed/Medline, EMBASE, and the Cochrane Controlled Register of Trials (CENTRAL) up to March 8, 2022. The search terms included Mycobacterium avium complex, MAC, amikacin, and liposomal amikacin.
RESULTS
After reviewing 1284 records, four papers met the inclusion criteria, including three clinical trials and one prospective cohort study. These studies showed that adding LAI to guideline-based therapies can increase sputum culture conversion rate and achieve early sustained (negative sputum culture results for 12 months with treatment) and durable (negative sputum culture results for three months after treatment) negative sputum culture. In addition, extended LAI use was a potential benefit in patients considered refractory to initial treatment. The most prevalent treatment-emergent adverse events (TEAE) reported in the LAI group were the respiratory TEAE.
CONCLUSIONS
LAI could increase the sputum culture conversion rate and achieve early sustainable, durable negative sputum culture. However, additional large-scale research is required to confirm the results.
Topics: Humans; Amikacin; Mycobacterium avium Complex; Anti-Bacterial Agents; Liposomes; Mycobacterium avium-intracellulare Infection; Prospective Studies; Macrolides; Drug Resistance, Bacterial; Lung Diseases
PubMed: 36574432
DOI: 10.1371/journal.pone.0279714 -
Frontiers in Immunology 2022Anti-interferon-γ autoantibody (AIGA) positivity is an emerging immunodeficiency syndrome closely associated with intracellular infection in individuals without human...
BACKGROUND
Anti-interferon-γ autoantibody (AIGA) positivity is an emerging immunodeficiency syndrome closely associated with intracellular infection in individuals without human immunodeficiency virus (HIV). However, the information on epidemiology, pathogen spectrum, and immunotherapy among these patients lack a systematic description of large data.
METHODS
This systematic literature review and multicenter retrospective study aimed to describe the pathogen spectrum and review treatment strategies among patients with AIGA positivity.
RESULTS
We included 810 HIV-negative patients with AIGA positivity infected with one or more intracellular pathogens. Excluding four teenagers, all the patients were adults. The most common pathogen was nontuberculous mycobacteria (NTM) (676/810, 83.5%). A total of 765 NTM isolates were identified in 676 patients with NTM, including 342 (44.7%) rapid-grower mycobacteria, 273 (35.7%) slow-grower mycobacteria, and 150 (19.6%) unidentified NTM subtype. Even with long-term and intensive antimicrobial treatments, 42.6% of patients with AIGA positivity had recurrence and/or persistent infection. Sixty-seven patients underwent immunoregulatory or immunosuppressive therapy, and most (60) achieved remission. The most common treatment strategy was rituximab (27/67, 40.3%) and cyclophosphamide (22/67, 32.8%), followed by cyclophosphamide combined with glucocorticoids (8/67, 11.9%).
CONCLUSIONS
Intracellular pathogen was the most common infection in patients with AIGA positivity. The predominant infection phenotypes were NTM, varicella-zoster virus, , and spp., with or without other opportunistic infections. AIGA immunotherapy, including rituximab or cyclophosphamide, has yielded good preliminary results in some cases.
Topics: Adult; Humans; Adolescent; Retrospective Studies; Mycobacterium Infections, Nontuberculous; Autoantibodies; Rituximab; Nontuberculous Mycobacteria; Immunotherapy; Cyclophosphamide; HIV Infections; Multicenter Studies as Topic
PubMed: 36569827
DOI: 10.3389/fimmu.2022.1051673 -
ERJ Open Research Oct 2022Immune checkpoint inhibitors (ICIs) are drugs growingly employed in the treatment of cancers, but there are still uncertainties about their possible role in the risk of...
Immune checkpoint inhibitors (ICIs) are drugs growingly employed in the treatment of cancers, but there are still uncertainties about their possible role in the risk of developing nontuberculous mycobacteria (NTM) infections. To understand this, we performed a systematic review of the literature including studies published between 20 June 2012 and 20 June 2022 which described the occurrence of NTM infections among patients treated with ICIs. Overall, we included seven studies describing nine patients with NTM infection occurring during ICIs therapy. NTM infections occurring during ICIs therapy are mainly caused by germs belonging to the , involve primarily the lungs, on average 1 year after the start of treatment, and are not associated with immunosuppressive treatments.
PubMed: 36451841
DOI: 10.1183/23120541.00364-2022 -
Respiratory Medicine Dec 2022Nontuberculous mycobacterial (NTM) pleuritis is an uncommon manifestation of NTM infection. Case reports and small case series have shown a variable clinical course and...
BACKGROUND
Nontuberculous mycobacterial (NTM) pleuritis is an uncommon manifestation of NTM infection. Case reports and small case series have shown a variable clinical course and high mortality rates.
OBJECTIVE
To describe patients' characteristics, clinical presentation and outcomes of NTM pleural infections.
METHODS
A systematic review of cases of NTM pleural infections published in PubMed-indexed journals from 1980 to 2021.
RESULTS
A total of 206 cases of NTM pleural infections were found and analyzed. Fifty-eight percent of cases were males. The mean age was 57.5 yrs (range 9-87 yrs). Forty-three percent of patients were immunosuppressed, and 43% had a chronic lung disease; thirty-two percent had neither risk factor. In addition to the pleural infection, 67% of cases had a concurrent pulmonary NTM infection, and in 18 cases there was another extrapulmonary site of NTM infection. In 29% of cases the pleural infection was the sole manifestation of NTM disease. The most common isolated mycobacterium was Mycobacterium avium complex (65%). Fifty-three percent and 26% of patients required pleural effusion drainage and a surgical intervention, respectively, to treat the infection, in addition to anti-NTM chemotherapy. Forty percent of patients developed pneumothorax, 16% suffered from empyema, and 16.5% had broncho-pleural fistula. The reported mortality rate was 24%.
CONCLUSION
NTM pleural infections may arise in immunocompetent and immunosuppressed patients, with or without chronic lung disease or concurrent NTM pulmonary infection. These infections carry a poor prognosis and a high risk of complications requiring surgical interventions in addition to anti-NTM chemotherapy.
Topics: Male; Humans; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Female; Retrospective Studies; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Mycobacterium avium Complex; Lung Diseases
PubMed: 36335889
DOI: 10.1016/j.rmed.2022.107036 -
The Journal of Heart and Lung... Feb 2023Patients with structural lung disease and immunocompromised status are at increased risk of pulmonary non-tuberculous mycobacteria (NTM) infection. However, literature... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients with structural lung disease and immunocompromised status are at increased risk of pulmonary non-tuberculous mycobacteria (NTM) infection. However, literature on NTM in lung transplant recipients (LTR) is limited. We sought to systematically review the literature and perform a meta-analysis to examine associations with NTM disease and isolation in LTRs and their influence on mortality and chronic lung allograft dysfunction (CLAD).
METHODS
A literature search of MEDLINE and Embase was performed on February 23, 2022. NTM disease was defined according to international guidelines. Isolation was defined as any growth of NTM in culture. Odds ratios (OR) were pooled for risk factors of NTM disease or isolation, and hazard ratios (HR) were pooled for mortality or CLAD.
RESULTS
Eleven studies totaling 3,371 patients were eligible for inclusion, 10 of which underwent meta-analysis. Cystic fibrosis (OR 1.84, 95% confidence interval [CI] 1.03-3.30; I = 0%) and pre-transplant NTM isolation (OR 2.40, 95% CI 1.20-4.83; I = 0%) were associated with NTM disease. Only male sex was associated with NTM isolation (OR 1.45, 95% CI 1.01-2.10; I = 0%). NTM disease was associated with increased mortality (HR 2.69, 95% CI 1.70-4.26; I = 0%) and CLAD (HR 2.11, 95% CI 1.03-4.35; I = 44%). NTM isolation was not associated with mortality in pooled analysis or CLAD in 1 included study.
CONCLUSIONS
NTM disease, but not isolation, is associated with worse outcomes. Several factors were associated with development of NTM disease, including cystic fibrosis and pretransplant NTM isolation. Strategies to optimize prevention and treatment of NTM disease in lung transplant recipients are needed.
Topics: Humans; Male; Nontuberculous Mycobacteria; Mycobacterium Infections, Nontuberculous; Cystic Fibrosis; Transplant Recipients; Lung Transplantation; Retrospective Studies; Lung; Risk Factors
PubMed: 36334962
DOI: 10.1016/j.healun.2022.10.004