Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • There have been increasing reports of NTM infection after ta

    2018-11-12

    There have been increasing reports of NTM infection after tattooing in recent years. The majority of cases are related to M. chelonae infection. M. abscessus infection after tattooing was rarely reported in the literature, as summarized in Table 1. M. abscessus infection is particularly virulent and treatment is challenging. Management is individualized and should consider multimodality management such as surgical debridement, abscess drainage, and systemic antibiotics, either singly or in combined treatment regimens. Clarithromycin became the drug of choice in the 1990s with therapeutic success for pulmonary infection. However, inducible macrolide resistance related to fty720 of intrinsic erm gene has been demonstrated in M. abscessus subspecies bulletii and abscessus. Besides, acquired mutations of rrl gene encoding for the 23S rRNA have also been identified to cause macrolide resistance. Because of the varied in vitro drug susceptibility of M. abscessus, The Clinical and Laboratory Standards Institute recommends testing M. abscessus for sensitivity to a panel of antibiotics, including clarithromycin, aminoglycosides, fluoroquinolones, imipenem, doxycycline, tigecycline, cefoxitin, cotrimoxazole, and linezolid. Among these agents, clarithromycin (83–99%), aminoglycoside (amikacin: 87–95%, isepamicin: 96%, tobramycin: 36–95%), cefoxitin (11–99%) and tigecycline (100%) have the best in vitro antimycobacterial activity. There was variable susceptibility to imipenem (8–55%) and fluoroquinolones (10–73%). Poor in vitro antimycobacterial activity was noted with tetracyclines (5–10%), linezolid (23%), and sulfamethoxazole (1–12%). Monotherapy with clarithromycin could be considered for localized cutaneous infection in immunocompetent patients. For serious skin and soft tissue infection caused by M. abscessus, combination treatment with clarithromycin and parenteral medications (amikacin, cefoxitin, or imipenem) is recommended. Consensus treatment guidelines regarding the treatment protocol of cutaneous infection by rapid-growth mycobacteria are not well established. The treatment duration is mainly based on the expert opinion or the experiences in case series or case reports at present. In a case review performed in Taiwan, 30 patients with cutaneous, rapidly growing mycobacterial infection showed resolution after antibiotic treatment for 4–12 months. According to expert opinions, the recommended length of treatment for cutaneous RGM infection is 4 months for mild disease and 6 months for serious disease. In the updated statement of the American Thoracic Society and Infectious Diseases Society of America, a minimum of 4 months of therapy is needed to provide a high likelihood of cure for severe M. abscessus infection. Effective disinfection before invasive procedures is necessary. Alcohol, chlorhexidine gluconate (CHG), and povidone–iodine (PVI) are widely used disinfectants for skin preparation before surgery. Alcohol has bactericidal, mycobactericidal, fungicidal, and virucidal activity but does not destroy bacterial spores and has no appreciable residual activity. CHG has antimicrobial activity against bacteria, fungi, and enveloped viruses and shows a sustained effect even in the presence of organic material. However, it inefficiently kills mycobacteria and bacterial spores. PVI has the widest antimicrobial spectrum, including bacteria, mycobacteria, spores, fungi, and enveloped viruses, but loses effectiveness in the presence of organic material. Both CHG and PVI are available as aqueous or alcohol-based solutions. Many studies have been conducted regarding preoperative antiseptics. Chlorhexidine may decrease surgical site infection (SSI) rates compared with PVI. Alcohol-based agents, either chlorhexidine–alcohol or iodine–alcohol are likely superior to aqueous agents. Although not statistically significant, there is a trend toward superiority for chlorhexidine–alcohol over iodine–alcohol in preventing SSI. PVI and alcohol have an advantage over chlorhexidine for antimycobacterial activity. PVI may be the most useful antiseptic for prevention of mycobacterial infection, as nearly all strains of mycobacteria can be eradicated within 30 seconds with 0.02% PVI, while a 1-minute duration of disinfection with alcohol is suggested due to the emergence of alcohol-resistant NTM. As a result, disinfection with a combined regimen of chlorhexidine–alcohol or iodine–alcohol for an adequate waiting period seems to be the most effective method to prevent SSI and mycobacterial infection.