title: Postoperative Mycoplasma hominis infections after neurosurgical intervention.
abstract: OBJECTIVE
  Mycoplasma hominis is a rare cause of infection after neurosurgical procedures. The Mycoplasma genus contains the smallest bacteria discovered to date. Mycoplasma are atypical bacteria that lack a cell wall, a feature that complicates both diagnosis and treatment. The Gram stain and some types of culture media fail to identify these organisms, and typical broad-spectrum antibiotic regimens are ineffective because they act on cell wall metabolism. Mycoplasma hominis commonly colonizes the genitourinary tract in a nonvirulent manner, but it has caused postoperative, postpartum, and posttraumatic infections in various organ systems. The authors present the case of a 17-year-old male with a postoperative intramedullary spinal cord abscess due to M. hominis and report the results of a literature review of M. hominis infections after neurosurgical procedures. Attention is given to time to diagnosis, risk factors for infection, ineffective antibiotic regimens, and final effective antibiotic regimens to provide pertinent information for the practicing neurosurgeon to diagnose and treat this rare occurrence.
  
  
  METHODS
  A PubMed search was performed to identify reports of M. hominis infections after neurosurgical procedures.
  
  
  RESULTS
  Eleven cases of postneurosurgical M. hominis infection were found. No other cases of intramedullary spinal cord abscess were found. Initial antibiotic coverage was inadequate in all cases, and diagnosis was delayed in all cases. Multiple surgical interventions were often needed. Once appropriate antibiotics were started, patients typically experienced rapid resolution of their neurological symptoms. In 27% of cases, a suspicious genitourinary source other than urinary catheterization was identified.
  
  
  CONCLUSIONS
  Postoperative M. hominis infections are rarely seen after neurosurgical procedures. They are typically responsive to appropriate antibiotic therapy. Mycoplasma infection may cause prolonged hospitalization and multiple returns to the operating room due to delay in diagnosis. Early clinical suspicion with appropriate antibiotic coverage could help prevent these significant complications.
authors.affiliation: Section of Neurosurgery and.
authors.forename: Wesley J
authors.initials: WJ
authors.lastname: Whitson
authors.forename: Perry A
authors.initials: PA
authors.lastname: Ball
authors.forename: S Scott
authors.initials: SS
authors.lastname: Lollis
authors.forename: Jason D
authors.initials: JD
authors.lastname: Balkman
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002574:Cervical Vertebrae / Q000293:injuries*; D057210:Delayed Diagnosis; D013354:Empyema, Subdural / Q000209:etiology; D020802:Epidural Abscess / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006801:Humans; D007165:Immunosuppression Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D000077266:Moxifloxacin; D009175:Mycoplasma Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D019535:Mycoplasma hominis / Q000187:drug effects / Q000302:isolation & purification; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D013117:Spinal Cord Compression / Q000209:etiology; D013124:Spinal Injuries / Q000150:complications* / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D000077266:Moxifloxacin
keywords: EVD = external ventricular drain; IUD = intrauterine device; MVC = motor vehicle collision; Mycoplasma hominis; PCR = polymerase chain reaction; SCI = spinal cord injury; UTI = urinary tract infection; WBC = white blood cell; abscess; brain; infection; intramedullary; spine