Mycobacterium Chelonae Follow-up
- Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD more...
Further Outpatient Care
The frequency of outpatient visits is determined by the extent of the disease, its sequelae, and whether the patient is receiving oral or intravenous therapy. Initially, patients on oral antibiotics should be evaluated at least monthly for signs of adverse events. More frequent visits may be necessary for patients with parenteral therapy and intravascular catheters to evaluate for complications and line infections.
Outpatients taking aminoglycoside therapy should undergo periodic (at least weekly) assessment of renal function, hearing, and antibiotic levels to avoid toxicity.
Monthly sputum cultures are recommended in patients with pulmonary disease to determine the efficacy and duration of therapy.
Further Inpatient Care
Most patients do not require inpatient care. The duration of inpatient care is dictated by the time needed to recover from any procedures performed.
Inpatient & Outpatient Medications
Antibiotics are typically administered daily (see Medication). Infrequent dosing schedules (eg, 2-3 times per week) have not been extensively evaluated and are not generally recommended without expert opinion.
One exception is the administration of aminoglycosides, which have been shown to have efficacy when given 3 times a week in combination with other agents given daily.
Patients who require intravenous antibiotic therapy but who are unable to receive home intravenous therapy need to be placed in a facility capable of administering antibiotics.
Patients with refractory disease may require a referral to a specialty center (usually as an outpatient rather than as an inpatient transfer).
No specific deterrence methods are available. Mycobacterium chelonae and Mycobacterium abscessus are ubiquitous organisms.
Isolation is not indicated.
Patients with disease due to nontuberculous mycobacteria (NTM) should be considered for treatment prior to starting anti–tumor necrosis factor-alpha (TNF α) agents, basiliximab, therapeutic corticosteroids, immunosuppressive therapy, and cytotoxic chemotherapy.
If an M chelonae or an M abscessus infection is believed to be nosocomial, notify hospital infection control. Finding even a single case of nosocomial NTM may warrant an investigation.
Complications of M chelonae infections may include the following:
- Severe lung disease or disseminated disease may cause death.
- Skin lesions and subsequent debridement may be disfiguring.
- Loss of surgically implanted prosthetic devices may occur.
- Antimycobacterial monotherapy may lead to drug resistance.
- Antimycobacterial chemotherapy of all types may be associated with adverse drug reactions, organ failure, and death.
With debridement and antibiotic therapy guided by susceptibility data, the prognosis is very good for most infections. Prognosis is worse if the patient is immunocompromised or noncompliant with therapy, which can be prolonged and poorly tolerated.
Lung disease may be difficult or impossible to eradicate. Chronic suppression of the infection and slowing of lung disease progression may be the only achievable goals in this setting.
Cure of infected implants that cannot be removed may be impossible and require antimicrobial suppressive therapy. Infection of cosmetic implants and procedures can be disfiguring.
Unacceptable toxicities with prolonged antibiotic use may develop, particularly with linezolid (lactic acidosis, neuropathy, myelosuppression), aminoglycosides (renal failure, hearing loss, tinnitus), and fluoroquinolones (tendon rupture).
Educate patients on the importance of adherence with multiple drug regimens to avoid the development of antibiotic resistance.
Patients may confuse this disease with tuberculosis. Reassure patients that they are not contagious to others.
Discuss possible medication adverse effects with patients to increase the chances of early detection. Advise patients to avoid prevent pregnancy if possible. If pregnancy is present, expert consultation is recommended.
For excellent patient education resources, see eMedicineHealth's patient education article Bronchoscopy.
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