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Volume 25, Number 6—June 2019
CME ACTIVITY - Synopsis

Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA

Noah Goldstein1, J. Benjamin St. Clair1, Shannon H. Kasperbauer, Charles L. Daley, and Bennie LindequeComments to Author 
Author affiliations: University of Colorado, Aurora, Colorado, USA (N. Goldstein, J.B. St. Clair, S.H. Kasperbauer, B. Lindeque); University of Chicago, Chicago, Illinois, USA (J.B. St. Clair); National Jewish Health, Denver, Colorado, USA (S.H. Kasperbauer, C.L. Daley)

Main Article

Table 2

Surgical treatment of patients with nontuberculous mycobacterial musculoskeletal infections, Colorado, USA*

Patient no. Site Previous surgeries Symptom onset to first surgery, mo Surgeries for control of infection at UCH
 Time between surgeries, mo First visit to definitive procedure, mo Length of follow-up, mo
First procedure(s) Definitive procedure
1
 Multiple joints†
Multiple I&Ds, below-knee amputation
 UNK
 I&D, excision of soft-tissue masses, debridement, synovectomy, amikacin bead implantation
Wide excision of right calf
 36
 22
 7
2
 Left foot
 Debridement, amputation L 5th toe, nodule excision
 2
 Debridement of dorsum of left foot
 Excisional debridement of left foot
 17
 14
 60
3
 Left hip (PJI)
 UNK
 UNK
 Debridement and polyethylene exchange
 Hemi-pelvectomy
 31
 38
 14
4
 Left thigh
 None
 18
 NA
 Above-knee amputation stump revision
 NA
 14
 1
5
 Right hand
 None
 9
 NA
 Amputation of right hand and forearm
 NA
 3
 37
6
 Right hip (PJI)
 None
 9
 Resection arthroplasty, tobramycin cement spacer
 Revision THA
 4
 6
 49
7
 Multiple joints‡
 I&D
 1
 Hardware removal, I&D, amikacin bead implantation, arthrotomy and osteotomy with amikacin cement, soft-tissue excisions
 Excisional debridement of left forearm and right foot with amikacin bead placement§
 51
 51
 2
8
 Left knee, right hip
 None
 UNK
 I&D, amikacin cement spacer
 TKA with tumor prosthesis, gentamicin cement, amikacin beads
 7
 8
 48
9
 Left knee (PJI)
 Explant with antimicrobial spacer, I&D
 4
 I&D, explantation, tobramycin spacer, intramedullary nail with tobramycin cement, revision of spacer
 Revision TKA with tobramycin cement and amikacin beads
 20
 12
 20
10
 Left knee
 Arthroscopic meniscectomy, synovial biopsy, aspirations, arthroscopic synovectomy
 2
 Radical synovectomy, amikacin bead implantation, resection arthroplasty, knee-spanning intramedullary nail with tobramycin cement
 TKA with tumor prosthesis and tobramycin cement
 40
 12
 4
11
 Right knee (PJI)
 None
 12
 Explantation, amikacin spacer, I&D, intramedullary nail with amikacin cement
 Revision TKA with gentamicin cement and amikacin beads
 7
 11
 17
12
 Left knee (PJI)
 I&D, polyethylene exchange
 0
 Explantation, gentamicin cement spacer
 Revision TKA with tobramycin cement and amikacin beads
 12
 5
 20
13
 Right knee (PJI)
 Explant, I&D, antimicrobial spacers
 3
 Revision TKA, I&D, intramedullary nail with amikacin cement
 Revision TKA with amikacin cement and amikacin beads
 14
 6
 1
14 Right elbow None 8 Wide excision of right forearm, nodule excision Wide excision of right forearm 4 10 47

*I&D, irrigation and debridement; NA, not applicable; PJI, prosthetic joint infection, THA, total hip arthroplasty; TKA, total knee arthroplasty; UNK, unknown.
†Infection was present in patient’s left thigh and knee, and right talus, ankle joint, and subtalar joint.
‡Infection was present in patient’s left elbow, buttock, forearm, calf, right ankle and thigh, and both feet.
§Because this patient is in treatment for chronic disseminated infection, definitive procedure is defined as the most recent surgical procedure.

Main Article

1These first authors contributed equally to this article.

Page created: May 24, 2019
Page updated: May 24, 2019
Page reviewed: May 24, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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