Post-surgical Infections Caused by Non-tuberculous Mycobacteria: A Case Series

Non-Tuberculous Mycobacteria (NTM) are increasingly recognised as causes of chronic post-surgical infections, particularly following procedures involving prosthetic materials. Delayed diagnosis is common due to sterile routine bacterial cultures and negative routine Tuberculosis (TB) molecular tests. Three cases of postsurgical NTM infections were reported. The first case involved a 53-year-old diabetic male with chronic synovitis of the knee, necrotising myofasciitis of the thigh and osteomyelitis of the femur caused by Mycobacterium intracellulare. Diagnosis was established by automated Acid Fast Bacilli (AFB) culture BACTEC Mycobacteria Growth Indicator Tube (BACTEC MGIT) and species identification by MALDI-TOF. The patient was treated with clarithromycin, rifampicin, and ethambutol for one year with clinical improvement. The second case was a mesh infection following laparoscopic Trans-Abdominal Pre-Peritoneal (TAPP) hernia repair in a 46-year-old male. Mycolicibacterium fortuitum was grown in AFB culture. Management included mesh removal and combination therapy with amikacin, doxycycline, and levofloxacin for three months, resulting in complete recovery. The third case involved a 63-year-old diabetic female with mesh infection after laparoscopic hernioplasty. The bacterial isolate was identified as Mycobacteroides abscessus. Surgical mesh removal followed by multidrug therapy with clarithromycin, doxycycline and levofloxacin for four months led to successful resolution. NTM should be suspected in persistent postsurgical infections unresponsive to conventional antibiotics, especially when routine bacterial cultures are sterile. AFB culture, NTM species identification, and susceptibility-guided multidrug therapy combined with surgical removal of infected prosthetic material are essential for favorable outcomes. Strengthening infection control practices and appropriate sterilisation techniques for surgical instruments are crucial to prevent healthcare-associated NTM infections.