Rapidly growing Mycobacteria (RGM) are an uncommon cause of infection in breast reconstructive surgery. Patients with breast cancer may be at an increased risk for this infection due to their immunosuppression from chemotherapy and radiation therapy, a history of previous surgery, and possible local lymphedema.
We retrospectively reviewed all cases of mycobacterial infection occurring in patients with breast cancer from January 2005 to January 2015 at the Moffitt Cancer Center.
Thirteen isolates were identified with 11 cases occurring unilaterally and two cases bilaterally. The median age was 54.8 years (range 33 -77). The median time from onset of symptoms to diagnoses was 5.7 weeks (range, 2-32). Fifty percent of patients had a history of prior chemotherapy and 36% of prior radiotherapy. In 54.5% of patients the infection presented after mastectomy with with a tissue expander. All the patients were explanted (n=8) or the silicone implant was removed (n=1). The most common isolates were M. abscessus (n=9), followed by M. fortuitum (n=2). M. fortuitum isolates were susceptible to ciprofloxacin, trimethroprim/sulfamethoxazole, linezolid and amikacin. M. abscessuswas susceptible to clarithromycin, some isolates were susceptible to amikacin, but all were resistant to ciprofloxacin, doxycycline, minocycline, moxifloxacin and trimethoprim/sulfametoxazole. The treatment regimen was individualized based on susceptibilities with all receiving combination of antibiotics with mostly azithromycin and another agent. There was no mortality in any of the cases. All patients were cured after surgical extraction and prolonged antibiotic treatment lasting 3 months on average.
RGM infection after breast cancer reconstructive surgery is infrequent, with a prevalence similar to other published case series in patients without cancer. RGM should be considered in patients with infections who do not respond to usual antibiotic therapy. M. abscessus and M fortuitum, were the most common cause of these RGM infections. Due to their unique susceptibility patterns, prolonged combination antibiotic therapy is indicated along with removal of the implant
J. Paruolo, None
M. Ho, None
K. Kynaston, None
J. Greene, None
A. Velez, None