title: Mycobacterium abscessus infection in a burn intensive care unit patient.
abstract: BACKGROUND
  Infection is the leading cause of death in burn patients. Historically, this was due to burn wound sepsis but pneumonia has now emerged as the most common source. In light of the increasing incidence of multi-drug-resistant organisms, the description of rare infections is paramount in continuing the fight against deadly pathogens. We aim to describe the second case of non-tuberculous mycobacterium (NTM) reported in a burn patient. Difficulties in diagnosis and management will also be highlighted.
  
  
  METHODS
  A 70-y-old Caucasian female, with a past medical history for type 2 diabetes mellitus, was transferred to our facility after a house fire. She had sustained a 28% total body surface area (TBSA) flame burn to her neck, torso, and all four extremities. She underwent excision and grafting on hospital day five with multiple subsequent attempts at excision and grafting due to graft loss. On hospital day 14, a tracheostomy was performed. Her hospital course was complicated by ongoing respiratory failure, renal injury, and sepsis.
  
  
  RESULTS
  Mycobacterium abscessus was found on blood cultures from central venous catheters and arterial line catheters as well as on tracheal aspirate and bronchoalveolar lavage (BAL) on hospital day 86. Imaging then revealed multiple pulmonary nodular densities with patchy ground-glass opacities. After multiple adjustments to the antibiotic regimen, tigecycline, clarithromycin, and cefoxitin therapy was started. She remained on this regimen for almost 4 wks. Her other infections included Acinetobacter baumanii treated with tobramycin and colistin, as well as Candida albicans for which she received fluconazole. Ultimately, her clinical state worsened leading to withdrawal of care.
  
  
  CONCLUSIONS
  Sepsis NTM is rare in burn patients with only one other case described in the English-language literature. Both cases reflect differences in diagnosis and management. This highlights the need to discuss rare infections in an attempt to broaden the clinician's awareness of such pathogens, as well as to collaborate to form a consensus about their management.
authors.affiliation: Division of Trauma and Critical Care, Jackson Memorial Hospital/University of Miami Burn Center, University of Miami Miller School of Medicine , Miami, Florida.
authors.forename: Tanaz
authors.initials: T
authors.lastname: Vaghaiwalla
authors.forename: Shevonne S
authors.initials: SS
authors.lastname: Satahoo
authors.forename: Rolla
authors.initials: R
authors.lastname: Zarifa
authors.forename: Marc
authors.initials: M
authors.lastname: Dauer
authors.forename: James S
authors.initials: JS
authors.lastname: Davis
authors.forename: Doreann
authors.initials: D
authors.lastname: Dearmas
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pizano
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
mesh_terms: D000150:Acinetobacter / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002056:Burns / Q000150:complications* / Q000601:surgery; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D009161:Mycobacterium / Q000145:classification / Q000302:isolation & purification*; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology / Q000473:pathology*; D014132:Trachea / Q000382:microbiology; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents