Successful treatment of inducible macrolide-resistant Mycobacterium abscessus subspecies abscessus surgical site infection after cosmetic surgery

This is the authors' abstract. We don't add key points for this paper.

Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium that causes extrapulmonary infections, including surgical site infections. Mycobacterium abscessus subsp. abscessus (MAA) frequently develops macrolide resistance, resulting in difficult-to-treat infections. Recently, surgical site infections caused by MAAs after cosmetic surgeries have become a notable concern, particularly as the number of cosmetic surgery clinics in Japan continues to increase. Therefore, vigilance for MAA infections following cosmetic procedures is necessary. However, reports on the treatment of macrolide-resistant MAA are limited. We report a case of surgical site infection following cosmetic surgery caused by macrolide-resistant MAA. A 47-year-old woman developed subcutaneous erythema, induration, and fistula formation several months after a thread lift procedure. Exudate culture revealed MAA harboring a full-length erm41 gene associated with inducible macrolide resistance, and susceptibility testing confirmed macrolide resistance. Treatment was initiated with combination antimicrobial therapy, including imipenem/cilastatin, amikacin, and tigecycline for 4 weeks, followed by clofazimine and sitafloxacin for 11 months as maintenance therapy. Local debridement was performed; however, complete removal of the threaded material was not feasible because thread had dissolved. After 12 months of treatment, the fistula closed, and no recurrence occurred during follow-up. This case highlights the importance of considering MAA in surgical site infections following cosmetic surgery and suggests that individualized combination antimicrobial therapy based on susceptibility testing may lead to successful outcomes in macrolide-resistant extrapulmonary MAA.