For reasons that are unclear, the incidence of nontuberculous mycobacterial disease is increasing worldwide. Periprosthetic nontuberculous mycobacterial infections following augmentation mammaplasty and breast reconstruction have been reported previously in the form of case reports.
This retrospective case series examines periprosthetic nontuberculous mycobacterial infections in two western Canadian cities (Edmonton, Alberta, and Vancouver, British Columbia) over a 10-year time period.
Ten patients were identified, four of whom had bilateral infections. The most common isolate was Mycobacterium fortuitum. Clinical features were similar to nonmycobacterial periprosthetic infections. The median time to onset of symptoms was 4.5 weeks and the median time to culture an organism was 5.4 weeks. The median duration of antibiotic therapy was 22 weeks. Patients required a mean of three additional operations after diagnosis. Nine patients underwent explantation of the involved implant(s). Reimplantation was performed in six patients a median of 11.5 months after explantation. All cases of reimplantation were successful.
Experience with this postoperative complication is limited, as nontuberculous mycobacteria represent a minority of the pathogens responsible for periprosthetic infections. In the absence of specific features with which to identify patients at risk, the surgeon must be aware of the possibility of this infection. To achieve earlier diagnosis, the clinician should have a high index of suspicion in a patient with delayed onset of symptoms, negative preliminary cultures, and a periprosthetic infection that fails to resolve following a course of conventional antimicrobial treatment. With appropriate treatment, nontuberculous mycobacterial periprosthetic infections can be managed successfully.
Edmonton, Alberta, and Vancouver, British Columbia, Canada
From the Departments of Plastic and Reconstructive Surgery, Infectious Disease, Medicine and Pathology, and Public Health Sciences, University of Alberta; and Provincial Laboratory for Public Health; and Faculty of Medicine, Department of Plastic and Reconstructive Surgery, University of British Columbia; and Department of Laboratory Medicine, Mycobacteriology Laboratory, British Columbia Center for Disease Control.
Received for publication July 7, 2005; accepted October 14, 2005.
Presented at the Annual Meeting of the Canadian Society of Plastic Surgeons, in Hamilton, Ontario, Canada, June 2 through June 5, 2004.
Sheina A. Macadam, M.D., Division of Plastic Surgery and Burn Unit, University of British Columbia and Vancouver General Hospital, 2nd Floor, JPP 2, 855 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada, firstname.lastname@example.org