title: Isolation of Rapidly Growing Nontuberculous Mycobacteria in Wounds Following Combat-Related Injury.
abstract: Rapidly growing nontuberculous mycobacteria (RGNTM) have yet to be described in combat-related injuries. This study investigates the epidemiology, clinical findings, treatment, and outcomes of RGNTM infections among combat casualties wounded in Afghanistan from 2010 to 2012.
  
  
  
  Patients with RGNTM were identified from the Department of Defense Trauma Registry through the Trauma Infectious Disease Outcomes Study. Trauma history, surgical management, and clinical data were collected. Six isolates from patients requiring antimycobacterial therapy were sequenced.
  
  
  
  Seventeen cases were identified. Six cases, predominantly associated with Mycobacterium abscessus, required aggressive debridement and a median of 180 days of multidrug antimycobacterial therapy that included clofazimine. M. abscessus isolates expressed the erythromycin resistance methylase (erm(41)) gene for inducible macrolide resistance, yet there were no clinical treatment failures when macrolides were utilized in combination therapy. No clonal similarity between M. abscessus isolates was found. Eleven cases had positive wound cultures, but did not require antimycobacterial therapy. The median duration of time of injury to first detection of a RGNTM was 57 days.
  
  
  
  This represents the first report of RGNTM infections in war-wounded patients. RGNTM should be recognized as potential pathogens in grossly infected combat wounds. Surgical debridement and multidrug antimycobacterial therapy, when clinically indicated, was associated with satisfactory clinical outcomes.
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Fiske
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Homeyer
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Michael
authors.initials: M
authors.lastname: Zapor
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hartzell
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Tyler
authors.initials: T
authors.lastname: Warkentien
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Timothy
authors.initials: T
authors.lastname: Burgess
authors.affiliation: Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.
authors.forename: Erik
authors.initials: E
authors.lastname: Snesrud
authors.affiliation: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Paige
authors.initials: P
authors.lastname: Waterman
authors.affiliation: Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Nielsen
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Roseanne A
authors.initials: RA
authors.lastname: Ressner
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000453:epidemiology; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification* / Q000472:pathogenicity; D012042:Registries; D014857:Warfare; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000382:microbiology