美容手术相关非结核分枝杆菌感染的诊断和治疗方法

郭晶东; 陈波; 彭靓; 张冬梅; 侯海鑫; 李万同; 朱雄翔

doi:10.3760/cma.j.cn501225-20231031-00160

美容手术相关非结核分枝杆菌感染的诊断和治疗方法

doi: 10.3760/cma.j.cn501225-20231031-00160

1.
南方医科大学深圳医院整形烧伤科,深圳　　518101
2.
北部战区总医院烧伤科,沈阳　　110016
3.
李万同现在南方医科大学深圳医院整形烧伤科,深圳　　518101

基金项目:

广东省医学科研基金 B2022034

详细信息

通讯作者:
朱雄翔,Email：13991978530@163.com

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出版历程
- 收稿日期: 2023-10-31

Diagnosis and treatment methods of nontuberculous mycobacteria infections related to cosmetic surgery

1.
Department of Burn and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, China
2.
Department of Burn Surgery, Northern Theater Command General Hospital, Shenyang 110016, China
3.
Li Wantong is working at the Department of Burn and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, China

Funds:

Medical Scientific Research Foundation of Guangdong Province of China B2022034

More Information

Corresponding author: Zhu Xiongxiang, Email: 13991978530@163.com

摘要

摘要: 目的探讨美容手术相关非结核分枝杆菌（NTM）感染的诊断和治疗方法。方法该研究为回顾性观察性研究。2015年1月—2023年12月,南方医科大学深圳医院和北部战区总医院收治符合入选标准的美容手术相关NTM感染患者共24例,均为女性,年龄29~51岁,其中行溶脂针注射术者20例、面部线雕手术者2例、异物注射者1例、除皱手术者1例。NTM导致感染的临床表现：感染部位有散在暗紫红色皮下结节且边界不清,结节表面皮肤变薄伴破溃,破溃口可见粉白色鱼肉样组织及少量淡黄色渗出液。为提高NTM的检出率,可对创面分泌物联合固体组织标本进行细菌培养、多次细菌培养以及延长培养时间等。对感染部位行损伤控制性清创,并根据药物敏感试验结果进行包括使用抗生素在内的综合治疗。统计患者感染NTM的亚型及药物敏感试验结果、创面愈合时间及其间样本的细菌培养次数和手术清创次数。随访时,观察创面愈合情况。结果细菌培养结果显示,感染脓肿分枝杆菌者22例、偶发分枝杆菌者2例。药物敏感试验结果显示,NTM对克拉霉素、阿米卡星、多西环素等抗生素敏感。创面平均愈合时间为83.6 d,其间对标本进行平均2.85次细菌培养,行清创术的平均次数为2.52次。随访6个月~5年,患者创面全部愈合,其中22例患者外观基本正常,遗留轻微瘢痕；2例患者遗留明显瘢痕及凹陷。结论美容手术相关NTM感染的治疗困难,对感染部位进行损伤控制性清创能在保证创面愈合的同时减少对面部等美容部位的损伤及术后畸形。
- 外科,整形 /
- 非结核分枝杆菌 /
- 损伤控制性清创 /
- 内科综合治疗 /
- 创面修复
Abstract: Objective To investigate diagnosis and treatment methods of nontuberculous mycobacteria (NTM) infections related to cosmetic surgery. Methods This study was a retrospective observational study. From January 2015 to December 2023, 24 patients with NTM infections related to cosmetic surgery meeting the inclusion criteria were admitted to Shenzhen Hospital of Southern Medical University and Northern Theater Command General Hospital, all of whom were female and aged 29-51 years. Among them, 20 cases underwent lipolysis needle injection surgery, 2 cases underwent facial contouring surgery, 1 case underwent foreign body injection, and 1 case underwent wrinkle removal surgery. The clinical manifestations of infections caused by NTM included scattered dark purplish subcutaneous nodules at the infection site with unclear boundaries, thinning of the skin on the surface of the nodules and ulceration, and powdery-white fish meat like tissue and a small amount of light yellow exudation being seen at the ulceration. In order to improve the detection rate of NTM, bacterial culture of wound exudation combined with solid tissue samples, multiple bacterial cultures, and extending culture time were performed. All patients were treated with damage control debridement on the infected site and comprehensive treatment including the use of antibiotics based on the results of drug sensitivity tests. The types of NTM infections, drug sensitivity test results, wound healing time, number of bacterial cultures, and surgical debridement times were recorded. The wound healing was observed during follow-up. Results The bacterial culture results showed that there were 22 cases of infections with Mycobacterium abscessus and 2 cases with Mycobacterium fortuitum. The drug sensitivity test results showed that the NTM was sensitive to antibiotics such as clarithromycin, amikacin, and doxycycline. The average healing time of the wound was 83.6 days with an average of 2.85 times bacterial cultures on the specimen, and an average of 2.52 times of debridement surgery. Follow up for 6 months to 5 years, all wounds of the patients were healed. Among them, 22 patients had a basically normal appearance with slight scars, while 2 patients had obvious scars and depressions. Conclusions It is difficult to treat NTM infections related to cosmetic surgery. Damage control debridement for the infected site can ensure wound healing and reduce the damage and postoperative deformities in facial and other cosmetic areas.
- Surgery, plastic /
- Nontuberculous mycobacteria /
- Damage control debridement /
- Comprehensive medical treatment /
- Wound repair
郭晶东：手术操作、论文撰写；陈波、彭靓：数据统计、查找文献、论文修改；张冬梅、侯海鑫：病历资料收集；朱雄翔、李万同：手术设计、手术操作、论文审阅、经费支持

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参考文献(28)

[1]	马艳, 陆伟, 成诗明. 结核分枝杆菌潜伏感染现状及防控对策[J].解放军医学杂志,2023,48(6):634-642. DOI: 10.11855/j.issn.0577-7402.2023.06.0634.
[2]	WangXY, JiaQN, LiJ. Treatment of non-tuberculosis mycobacteria skin infections[J]. Front Pharmacol, 2023,14:1242156. DOI: 10.3389/fphar.2023.1242156.
[3]	MuellerMA, KanackMD, SinghJ, et al. Pediatric mandible reconstruction for osteomyelitis during largest reported mycobacterium abscessus outbreak[J]. J Craniofac Surg, 2020,31(1):274-277. DOI: 10.1097/SCS.0000000000006070.
[4]	刘政军, 卢才教, 郭海雷, 等. 人型结核分枝杆菌皮肤感染22例[J].中华烧伤杂志,2014,30(4):377-378. DOI: 10.3760/cma.j.issn.1009-2587.2014.04.025.
[5]	VaghaiwallaT, SatahooSS, ZarifaR, et al. Mycobacterium abscessus infection in a burn intensive care unit patient[J]. Surg Infect (Larchmt), 2014,15(6):847-849. DOI: 10.1089/sur.2014.052.
[6]	SoodG, ParrishN. Outbreaks of nontuberculous mycobacteria[J]. Curr Opin Infect Dis, 2017,30(4):404-409. DOI: 10.1097/QCO.0000000000000386.
[7]	DonohueMJ, MistryJH, DonohueJM, et al. Increased frequency of nontuberculous mycobacteria detection at potable water taps within the United States[J]. Environ Sci Technol, 2015,49(10):6127-6133. DOI: 10.1021/acs.est.5b00496.
[8]	PrevotsDR, AdjemianJ, FernandezAG, et al. Environmental risks for nontuberculous mycobacteria. Individual exposures and climatic factors in the cystic fibrosis population[J]. Ann Am Thorac Soc, 2014,11(7):1032-1038. DOI: 10.1513/AnnalsATS.201404-184OC.
[9]	E Y, HengshuZ. Clinical analysis of nontuberculous mycobacterial infection after minimally invasive plastic surgery and cosmetic surgery[J]. J Cosmet Dermatol, 2022,21(6):2523-2529. DOI: 10.1111/jocd.14395.
[10]	da SilvaJM, CrispimVR, da SilvaMG, et al. Characterization of non-tuberculosis mycobacteria by neutron radiography[J]. Appl Radiat Isot, 2013,77:84-88. DOI: 10.1016/j.apradiso.2013.02.009.
[11]	GravanteG, CarusoR, AracoA, et al. Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis[J]. Aesthetic Plast Surg, 2008,32(2):243-251. DOI: 10.1007/s00266-007-9068-8.
[12]	AlffenaarJW, MärtsonAG, HeysellSK, et al. Therapeutic drug monitoring in non-tuberculosis mycobacteria infections[J]. Clin Pharmacokinet, 2021,60(6):711-725. DOI: 10.1007/s40262-021-01000-6.
[13]	KumarC, ShrivastavaK, SinghA, et al. Skin and soft-tissue infections due to rapidly growing mycobacteria: an overview[J]. Int J Mycobacteriol, 2021,10(3):293-300. DOI: 10.4103/ijmy.ijmy_110_21.
[14]	中华医学会结核病学分会.非结核分枝杆菌病诊断与治疗指南(2020年版)[J].中华结核和呼吸杂志,2020,43(11):918-946.DOI: 10.3760/cma.j.cn112147-20200508-00570.
[15]	王鹏, 尹斌, 贾赤宇, 等. 免疫荧光双重染色对临床结核性创面石蜡组织中泡沫细胞及结核分枝杆菌显示效果的比较分析[J].中华烧伤杂志,2021,37(2):157-163. DOI: 10.3760/cma.j.cn501120-20200525-00285.
[16]	ShiCL, HanP, TangPJ, et al. Clinical metagenomic sequencing for diagnosis of pulmonary tuberculosis[J]. J Infect, 2020,81(4):567-574. DOI: 10.1016/j.jinf.2020.08.004.
[17]	GholoobiA, Masoudi-KazemabadA, MeshkatM, et al. Comparison of culture and PCR methods for diagnosis of mycobacterium tuberculosis in different clinical specimens[J]. Jundishapur J Microbiol, 2014,7(2):e8939. DOI: 10.5812/jjm.8939.
[18]	EdwardsLJ, PriceRN, KrauseVL, et al. Detection of Mycobacterium leprae by PCR testing of sputa from a patient with pulmonary cryptococcus coinfection in northern Australia[J]. J Clin Microbiol, 2014,52(10):3811-3812. DOI: 10.1128/JCM.01060-14.
[19]	AzadiD, MotallebiradT, GhaffariK, et al. Mycobacteriosis and tuberculosis: laboratory diagnosis[J]. Open Microbiol J, 2018,12:41-58. DOI: 10.2174/1874285801812010041.
[20]	FujiedaY, NinagawaK, MatsuiY, et al. Non-tuberculosis mycobacterium tenosynovitis with rice bodies in a patient with systemic lupus erythematosus[J]. Intern Med, 2020, 59(18):2317-2320. DOI: 10.2169/internalmedicine.4671-20.
[21]	KaduraS, KingN, NakhoulM, et al. Systematic review of mutations associated with resistance to the new and repurposed Mycobacterium tuberculosis drugs bedaquiline, clofazimine, linezolid, delamanid and pretomanid[J]. J Antimicrob Chemother, 2020, 75(8):2031-2043. DOI: 10.1093/jac/dkaa136.
[22]	WalkerTM, MiottoP, KöserCU, et al. The 2021 WHO catalogue of Mycobacterium tuberculosis complex mutations associated with drug resistance: a genotypic analysis[J]. Lancet Microbe, 2022,3(4):e265-e273. DOI: 10.1016/S2666-5247(21)00301-3.
[23]	RatnatungaCN, LutzkyVP, KupzA, et al. The rise of non-tuberculosis mycobacterial lung disease[J]. Front Immunol, 2020,11:303. DOI: 10.3389/fimmu.2020.00303.
[24]	DaleyCL, IaccarinoJM, LangeC, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline[J]. Clin Infect Dis, 2020,71(4):905-913. DOI: 10.1093/cid/ciaa1125.
[25]	刘宁, 李小兵, 张静琦. 直接携带游离肩胛皮瓣修复难治性创面[J].中华烧伤杂志,2010,26(3):228-229. DOI: 10.3760/cma.j.issn.1009-2587.2010.03.019.
[26]	张同威, 汪毅平, 贾赤宇. 清创后外用碱性成纤维细胞生长因子对新西兰兔结核性创面愈合的影响[J].中华烧伤杂志,2019,35(2):95-103. DOI: 10.3760/cma.j.issn.1009-2587.2019.02.004.
[27]	荣美玉, 贾赤宇. 单中心结核性创面与非结核性慢性难愈性创面患者的特点[J].中华烧伤杂志,2019,35(2):90-94. DOI: 10.3760/cma.j.issn.1009-2587.2019.02.003.
[28]	CusumanoLR, TranV, TlamsaA, et al. Rapidly growing Mycobacterium infections after cosmetic surgery in medical tourists: the Bronx experience and a review of the literature[J]. Int J Infect Dis, 2017,63:1-6. DOI: 10.1016/j.ijid.2017.07.022.

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图 1 患者面部线雕手术后非结核分枝杆菌引发感染的治疗效果。1A.面部线雕术后1个月,左眼眶下部红肿；1B.面部线雕术后2个月,左眼眶下脓肿再发伴破溃；1C.美容术后5个月,左颞部及面颊颧弓处出现散在脓肿；1D.美容术后8个月,左侧面颊靠近下颌缘处出现脓肿；1E.最后1次手术后1年随访,创面愈合良好

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