Abstract

Background

Mycobacterium marinum is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment consists of multiple antibiotics, sometimes combined with surgical debridement. There is little evidence for the choice of antibiotics, the duration of treatment, and the role of susceptibility testing.

Methods

We performed a retrospective cohort study of culture-confirmed M. marinum infections in the Netherlands in the 2011–2018 period. Clinical characteristics, in vitro susceptibility, extent of disease, treatment regimens, and outcomes were analyzed. Incidence was assessed from laboratory databases.

Results

Forty cases of M. marinum infection could be studied. Antibiotic treatment cured 36/40 patients (90%) after a mean treatment duration of 25 weeks. Failure/relapse occurred in 3 patients, and 1 patient was lost to follow-up. Antibiotic treatment consisted of monotherapy in 35% and 2-drug therapy in 63%. Final treatment contained mostly ethambutol–macrolide combinations (35%). Eleven patients (28%) received additional surgery. We recorded high rates of in vitro resistance to tetracyclines (36% of isolates). Tetracycline resistance seemed correlated with poor response to tetracycline monotherapy. The annual incidence rate was 0.15/100 000/year during the study period.

Conclusions

Prolonged and susceptibility-guided treatment results in a 90% cure rate in M. marinum disease. Two-drug regimens of ethambutol and a macrolide are effective for moderately severe infections. Tetracycline monotherapy in limited disease should be used vigilantly, preferably with proven in vitro susceptibility.

Details

Title
Treatment and Outcome of Culture-Confirmed Mycobacterium marinum Disease
Author
Hendrikx, Louise 1 ; Colette L M van Hees 2 ; Jurriaan E M de Steenwinkel 3   VIAFID ORCID Logo  ; Bax, Hannelore I 3 ; Sprong, Tom 4 ; Mulder, Bert 5 ; Jansz, Arjan 6 ; Arjanne van Griethuysen 7 ; Bosboom, Ron 8 ; Stemerding, Annette 9 ; Koetsier, Marjolein 10 ; Marco van Coevorden 10 ; Mourik, Bas C 11 ; Quint, Koen D 12 ; Ott, Alewijn 13 ; Dick van Soolingen 14 ; Kuipers, Saskia 15 ; Reinout van Crevel 16 ; Jakko van Ingen 15   VIAFID ORCID Logo 

1  Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center for Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands 
2  Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands 
3  Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands 
4  Department of Internal Medicine, Canisius Wilhelmine Hospital, Nijmegen, the Netherlands 
5  Department of Medical Microbiology, Canisius Wilhelmine Hospital, Nijmegen, the Netherlands 
6  PAMM Laboratory of Medical Microbiology, Veldhoven, the Netherlands 
7  Department of Medical Microbiology, Gelderse Vallei Hospital, Ede, the Netherlands 
8  Department of Medical Microbiology, Rijnstate Hospital, Arnhem, the Netherlands 
9  Department of Medical Microbiology, Gelre Hospital, Apeldoorn, the Netherlands 
10  Department of Dermatology, Gelre Hospital, Apeldoorn, the Netherlands 
11  Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands 
12  Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands 
13  Department of Medical Microbiology, Certe, Groningen, the Netherlands 
14  Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, the Netherlands 
15  Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands 
16  Radboudumc Center for Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands 
Publication year
2022
Publication date
Apr 2022
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ofid/ofac077
ProQuest document ID
3171141827
Copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.