A Series of Nontuberculous Mycobacterial Flexor Tenosynovitis Infections and Cost of Treatment

Abstract

Background Nontuberculous mycobacteria (NTM) are rare but potentially devastating causes of musculoskeletal infection and impairment in immunocompetent patients.

Purpose Given the sparse body of literature surrounding these infections, we describe a series of patients with and the cost of treatment of upper extremity NTM infections.

Patients and Methods In a retrospective review of seven patients with NTM infections of the upper extremity treated at a university hospital from 2010 to 2019, we assessed patient demographics, exposures, infection characteristics, management course, outcomes, and costs of treatment.

Results Insidious pain and swelling were the most common clinical manifestation of infection. Despite coupled surgical and medical management, recurrence was common. Two patients required amputation, and three others had lasting functional deficits. The most common pathogen was Mycobacterium avium complex (5 of 7). The estimated median charge related to management was $85,126 with a range from $8,361 to $1,66,229.

Conclusions The treatment of NTM infections is complex and expensive. Diagnosis is usually delayed, which further complicates the management of these patients who often suffer from lasting debilitation. Due to its potentially devastating course, NTM infection should be considered and tested for whenever flexor tenosynovitis is suspected. Regardless of initial presentation, our experience suggests that a protocol of serial surgical debridement immediately after tissue diagnosis is necessary for optimal outcomes. Furthermore, NTM infections require collaboration with infectious disease colleagues to guide antimicrobial regimens based on susceptibility testing and therapeutic drug monitoring for the recommended 6 to 12 months of therapy after the final operative debridement.

Level of Evidence This is a Level IV, case series study.

Keywords

cost analysis - Mycobacterium immunogenum - upper extremity infections - flexor tenosynovitis - nontuberculous mycobacteria

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. No identifiable information of the patient was included in this case series; therefore, informed consent was not required.

The cases described were managed at the University of Virginia

Publication History

Received: 20 November 2020

Accepted: 04 March 2021

Article published online:
04 May 2021

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