[Treatment of cutaneous infections due to Mycobacterium fortuitum: two cases].
BACKGROUND
Cutaneous infections due to Mycobacterium fortuitum, a rapidly growing environmental mycobacteria, are often iatrogenic, resulting from surgery or injection. We report two cases following plastic surgery and describe the outcome after surgery and antibiotics.


METHODS
Two immunocompetent women underwent abdominal plastic surgery and liposuction, which were complicated with recurrent abscesses one and 13 months later respectively. Cultures of bacteriologic samples isolated M. fortuitum in the two patients. The two strains exhibited different antibiotic sensibility profiles. The initial antibiotic therapy consisted of combined amikacin and moxifloxacin in both patients plus imipenem in one, followed by oral doxycycline and clarithromycin in one and moxifloxacin in the other for a total duration of nine and five months, respectively. In both cases, surgical treatment was also given before, during and after antibiotic therapy. No new lesions had appeared six months after the end of antibiotic therapy.


CONCLUSIONS
Cutaneous infections due to M. fortuitum are rare and secondary to iatrogenic skin wounds. The clinical appearance is not specific, accounting for delayed diagnosis. Treatment is difficult and there is no consensus. According to our experience, surgical treatment is essential whereas the efficacy of antibiotics, even involving multiple agents, seems more doubtful.
Régnier
S
S
Service des maladies infectieuses et tropicales, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Martinez
V
V
Veziris
N
N
Bonvallot
T
T
Meningaud
J-P
JP
Caumes
E
E
D034861:Abdominal Wall / Q000601:surgery*; D000284:Administration, Oral; D000328:Adult; D000583:Amikacin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001372:Aza Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use; D015187:Lipectomy / Q000009:adverse effects*; D008875:Middle Aged; D000077266:Moxifloxacin; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D019907:Mycobacterium fortuitum / Q000302:isolation & purification; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D013518:Surgery, Plastic / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D015378:Imipenem; D000583:Amikacin; D017291:Clarithromycin; D004318:Doxycycline; D000077266:Moxifloxacin