Non-tuberculous mycobacterial bone and joint infections - a case series from a tertiary referral centre in Australia

BackgroundNon-tuberculous mycobacteria (NTM) are rare causes of bone and joint infection (BJI) and there is limited evidence on which to base management decisions. This study describes 1 year of experience from a multi-disciplinary BJI team which collects data on all cases reviewed at a tertiary referral centre in Queensland, Australia.MethodsThe database was interrogated for all cases in which NTM were recovered from operative samples. Individual chart review was performed to collect the details of each case.ResultsA total of seven cases were managed between 1st February 2021 and 28th February 2022, comprising one patient with chronic osteomyelitis, three with fracture-related infections, two with prosthetic joint infections, and one with infection of a synthetic ligament graft. In contrast to pulmonary NTM infections, most patients were clinically well and immunocompetent, and most infections were propagated by direct inoculation. Time to diagnosis was unknown in three patients, with 1, 2, 2, and 5 months for the remaining four. Rapid growing NTM were diagnosed on routine cultures and specific mycobacterial cultures were confirmatory. Management was characterized by multiple stage surgical procedures and prolonged antimicrobial regimens.ConclusionsAntimicrobial complications were common; however, all patients were infection free at their latest follow up. Despite the inherent limitations, these results suggest that routinely ordering mycobacterial culture is of low yield. There is potential for shorter-term oral antimicrobial treatments. Prospective research is required to optimize treatment regimens and durations. Bone and joint infections (BJI) caused by non-tuberculous mycobacteria (NTM) are rare and there is a paucity of evidence on which to base management decisions. In this series of seven cases of NTM BJI, complications related to antimicrobial therapy were common, however, all patients were infection free at their latest follow up. The results of this paper suggest that routinely ordering mycobacterial culture is of low yield and there is potential for shorter-term oral antimicrobial treatments.image