Mycobacterium Chelonae Treatment & Management

Updated: Nov 14, 2017
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

Localized cutaneous infection usually resolves with appropriate antibiotics with combined indicated excision or debridement. An optimal drug regimen for Mycobacterium chelonae infection has not been established.

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Surgical Care

Aggressive debridement of infected soft tissue has always been advocated as a modality of therapy. Uncomplicated infections may not require surgical intervention, and it is not unusual for practitioners to try antimicrobial chemotherapy alone before undertaking a surgical procedure. Excision and debridement is currently recommended when infection is extensive, recurrent, or drug resistant. Abscess formation with or without sinus tract formation and bone involvement usually requires formal debridement. [25, 29] In addition, infections in patients intolerant of drug therapy may need surgical excision.

Any infected foreign body or implanted device usually must be removed in combination with antibiotic therapy to optimize the therapeutic outcome. [18, 20, 21, 27, 29]

Ocular infections usually require surgical intervention. [23]

Pulmonary infection only requires surgical intervention when it is extensive, cavitary, or nonresponsive to drug therapy. Surgery usually involves lobectomy or segmentectomy and has been reported to have acceptable morbidity and mortality in most cases with reasonable preserved lung function. [37]

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Consultations

Consultation with the following specialists may be indicated:

  • An infectious diseases specialist for diagnostic and therapeutic guidance

  • A pulmonologist for lung lesions, possible bronchoscopy, and therapeutic guidance

  • A dermatologist for possible biopsy of cutaneous lesions

  • A surgeon for debridement, biopsy or surgical guidance

Consider obtaining expert advice from the following institutions:

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Diet

No specific dietary restrictions are indicated.

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Activity

Patients with M chelonae infections are not contagious and should not be isolated.

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Prevention

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.

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Long-Term Monitoring

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.

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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. [38]

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Transfer

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).

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