Nontuberculous mycobacteria infection after autologous fat grafting: a systematic analysis
10.3760/cma.j.cn114453-20211218-00472
- VernacularTitle:自体脂肪移植术后非结核分枝杆菌感染的系统分析
- Author:
Hongfan DING
1
;
Xiao XU
;
Minliang CHEN
Author Information
1. 解放军总医院第四医学中心烧伤整形医学部，北京 100048
- Keywords:
Mycobacterium infections, nontuberculous;
Autologous fat grafting;
Postoperative complications
- From:
Chinese Journal of Plastic Surgery
2023;39(10):1138-1146
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically investigate the prevalence, diagnosis and treatment of nontuberculous mycobacteria (NTM) infection following autologous fat grafting.Methods:A comprehensive search and collection of domestic and international literature on NTM infection after autologous fat grafting was conducted based on established inclusion and exclusion criteria. The gender, age, surgical procedure, onset latency, time of diagnosis, NTM strain, clinical manifestations, treatment plan, and follow-up time of each selected patient were collected. Systematic analysis was performed on the collected data. The measurement data of normal distribution was expressed as Mean±SD, the data of skew distribution was expressed as M( Q1, Q3), count data was expressed as frequency and percentage. Results:The data of 72 patients from 31 studies were included in the analysis, with 1 male and 71 females, aged (36.7±11.7) years (ranging from 21 to 67 years). The follow-up period ranged from 2 months to 9 years, with a median time of 12 (6, 36) months. Infection sites after fat grafting included the face (65.3%, n=47), breast (20.8%, n=15), abdomen (9.7%, n=7), buttocks (8.3%, n=6), and limbs (2.8%, n=2). Among them, 65 cases (90.3%) were infected at the injection site, 2 cases (2.8%) were infected at the liposuction site, and 5 cases (6.9%) were infected at both the liposuction and injection sites. The identified strains of NTM were: M. abscessus in 53 cases (73.6%), M. chelonae in 10 cases (13.9%), M. fortuitum in 7 cases (9.7%), M. conceptionense in 1 case (1.4%), and mixed infection of M. abscessus/ M. chelonae in 1 case (1.4%). The average latency period was 25 (10, 30) days, ranged from four days to six months. The time of diagnosis was approximately 120 (68, 195) days (ranged from 30 days to two years). Sixty-nine patients (95.8%) underwent debridement, drainage, and negative pressure aspiration, with an average of more than 3 times of debridement treatments. All patients were treated with two or more antibiotics. Clarithromycin, amikacin, ciprofloxacin, and cefoxitin were the most frequently used antibiotics. The mean duration of treatment was 12 (7, 16) months (ranged 2.5 to 18 months). Conclusion:The most common strains of NTM infection after autologous fat grafting were M. abscessus, M. chelonae, and M. fortuitum, with a higher infection rate observed at the fat injection site compared to the liposuction site. The most common treatment strategy for NTM after diagnosis was early debridement followed by combined antibiotic therapy. However, it is challenging to accurately diagnose NTM infections, leading to a high rate of misdiagnosis and mistreatment. Therefore, healthcare professionals should increase their awareness of NTM infections and acquire knowledge on how to prevent, diagnose, and treat them.
