Successful bedaquiline-containing antimycobacterial treatment in post-traumatic skin and soft-tissue infection by Mycoba
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CASE REPORT
Open Access
Successful bedaquiline-containing antimycobacterial treatment in posttraumatic skin and soft-tissue infection by Mycobacterium fortuitum complex: a case report Johanna Erber1,2* , Simon Weidlich1,2, Tristan Tschaikowsky3, Kathrin Rothe2,4, Roland M. Schmid1,2, Jochen Schneider1,2 and Christoph D. Spinner1,2
Abstract Background: Mycobacterium fortuitum complex is a group of rapidly growing nontuberculous mycobacteria (NTM) associated with skin and soft-tissue infections after surgery or trauma. Treatment of NTM is challenging, due to resistance to multiple antimycobacterial agents. Bedaquiline is a diarylquinoline that inhibits mycobacterial ATPsynthase. The drug has recently been approved for the treatment of multidrug-resistant tuberculosis and evidence of its in vitro efficacy against NTM, including Mycobacterium fortuitum complex, has been published. Case presentation: A 20-year-old Caucasian woman with chronic skin and soft tissue infection in the lower leg following a traffic accident in Vietnam underwent a tedious journey of healthcare visits, hospital admissions, empiric antimicrobial treatments, surgical debridement and plastic reconstruction before definite diagnosis of Mycobacterium fortuitum complex-infection was established by culture from a tissue biopsy and targeted antimycobacterial therapy was administered. Histopathological examination revealed granulomatous purulent inflammation, which strongly supported the diagnosis. Genotypic identification was performed and broth microdilution for susceptibility testing showed macrolide resistance. Five weeks of induction treatment with intravenous amikacin, imipenem / cilastin, and oral levofloxacin was administered, followed by all-oral treatment with bedaquiline combined with levofloxacin for four months, which was well-tolerated and led to persistent healing with scars but without signs of residual infection. Conclusions: Bedaquiline is a promising novel agent for NTM treatment, although clinical data are limited and trials evaluating efficacy, safety, and resistance of bedaquiline are required. To our knowledge, this is the first reported case of successful in vivo use of bedaquiline for a skin and soft tissue infection caused by Mycobacterium fortuitum complex. Keywords: Mycobacterium fortuitum complex, Nontuberculous mycobacteria, Chronic wound infection, Bedaquiline, Rapidly growing mycobacteria, Case report * Correspondence: [email protected] 1 Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Department of Internal Medicine II, Ismaningerstrasse 22, 81675 Munich, Germany 2 German Center for Infection Research (DZIF), partner site Munich, Munich, Germany Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to
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