Surgical site infection of laparoscopic hernioplasty site with non-tuberculous mycobacteria—Mycolicibacterium fortuitum—Case reports with literature review

Abstract

Mesh infections have been described as “a surgeon’s biggest nightmare.” Infection with non-tuberculous mycobacteria (NTM) is often associated with the presence of a foreign substance, such as a catheter or mesh. Poorly sterilized laparoscopic instruments can also serve as a source of infection with NTM. Here, we report three cases of hernial mesh infections that followed laparoscopic surgery, caused by Mycolicibacterium fortuitum. NTM isolated in culture, from the samples were identified using 16s rRNA sequencing or Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI TOF MS). The patients presented with slowly progressive swelling at the surgical site over 1-2 months. The lesions healed following extensive surgical debridement and long-term antibiotics: fluoroquinolone with doxycycline/trimethoprim-sulfamethoxazole (6-10 months). Accurate diagnosis and prompt aggressive treatment are needed to cure NTM infections and prevent the development of complications, that can lead to prolonged recovery, multiple hospitalizations, and numerous antibiotic courses.

Keywords

Laparoscopy / mesh infection / Mycolicibacterium fortuitum

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press