Abstract
Background
Rapidly growing mycobacteria (RGM) bloodstream infections (BSI) are an emerging problem
often associated with therapeutic challenges. We review the epidemiology, treatment
and outcomes over a 5-year period of a heterogeneous group presenting to our institution
with RGM BSI.
Materials and Methods
A retrospective cohort study of patients with primary RGM BSI from January 2006-December
2011 was conducted. Patient characteristics (age, race, sex and comorbidities), infection
characteristics (catheter associated, hospital acquired, microbiology and antimicrobial
susceptibilities), therapy and outcomes were recorded and compared by species.
Results
Among 32 patients, 33 RGM BSI occurred. Patients had an average of 3-4 comorbidities,
most commonly malignancy (45.5%). Most isolates (30.3%) were Mycobacterium fortuitum or Mycobacterium mucogenicum (27.2%), followed by Mycobacterium abscessus/chelonae (18.2%) and Mycobacterium immunogenum (12.2%). In all, 85% were catheter associated and 27.3% were hospital acquired. Empiric
therapy was started in 19 (57.6%) patients and among these, it was adequate (at least
2 active agents based on susceptibilities) in 12 (63.2%). Among 21 patients with outcome
data, cure was assumed for 14 (66.7%). One death was attributable to RGM BSI. Cure
rates were higher among those who received adequate empiric therapy compared to those
who did not (83.3% versus 42.9%). In general, antibiotic susceptibility was favorable
across species for clarithromycin, amikacin and imipenem.
Conclusions
RGM BSI occurred in a population with multiple comorbidities, most commonly malignancy,
and most were catheter associated. Higher cures were seen among those who received
adequate empiric therapy and based on susceptibility data, a broad empiric regimen
of clarithromycin, amikacin and imipenem would be expected to be adequate.
Key Indexing Terms
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Article info
Publication history
Accepted:
October 29,
2015
Received:
September 8,
2015
Footnotes
☆The authors have no financial or other conflicts of interest to disclose.
Identification
Copyright
© 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
