Abstract
Mycobacterium goodii is a rapidly growing nontuberculous mycobacterium that was first described in 1999. Previous case reports of M. goodii have been associated with prosthetic tissue infection or soft tissue infection. To our knowledge, there is only one previous case report on M. goodii catheter-related infection. Here we report a case of central venous catheter infection with M. goodii complicated by bacteremia.
Keywords: Catheter-associated bloodstream infection, Mycobacterium goodii, Mycobacterium infection, nontuberculous mycobacteria
Mycobacterium goodii catheter-related infection is rare. Here we report a patient with pulmonary hypertension who was receiving epoprostenol by a central venous catheter that became infected with M. goodii and caused septicemia.
CASE DESCRIPTION
A 41-year-old woman with a history of type 2 diabetes, chronic hypoxic respiratory failure, and pulmonary hypertension on epoprostenol infusion presented to the hospital with fever, nausea, dysuria, and dyspnea for 2 days. She denied cough, peripheral edema, abdominal pain, and diarrhea. The blood pressure was 109/70 mm Hg; temperature, 100.1°F; heart rate, 117 beats/min; respiratory rate, 17 breaths/min; and oxygen saturation, 93% on 2 L oxygen (baseline home oxygen). Examination showed normal breath sounds. There was no erythema, swelling, bleeding, drainage, or tenderness at the right subclavian catheter site and no peripheral embolic signs. The catheter had been inserted for epoprostenol infusion therapy for pulmonary hypertension 1 year before this admission. The white cell count was 3.47 k/µL (neutrophils 90%, lymphocytes 6%); hemoglobin, 11.0 g/dL; and platelet count, 82 k/µL. Urinalysis showed no red blood or pyuria, no bacteria, and negative leukocyte esterase and nitrite. Chest x-ray showed no infiltrates. Computed tomography of the chest without contrast showed a small pericardial effusion. A transthoracic echocardiogram was negative for valvular abnormalities. The patient had persistent temperatures up to 103.5°F.
Blood culture from the day of admission grew Gram-variable rods, and the patient was started on piperacillin-tazobactam. The initial blood culture grew a rapidly growing Mycobacterium species. The catheter was removed and sent for Gram stain and culture. Repeat blood culture 2 days later also grew rapidly growing Mycobacterium species. The patient was started on an empiric regimen covering the three most common rapidly growing nontuberculous mycobacteria (NTM)—M. abscessus, M. fortuitum, and M. chelonae—with imipenem, clarithromycin, and amikacin while waiting for identification of the type of rapidly growing NTM. Repeat blood cultures on hospital day 1, day 3, and day 5 grew rapidly growing NTM. The catheter tip culture also grew a rapidly growing Mycobacterium species, which confirmed a true infection and ruled out contamination. Clarithromycin was switched to azithromycin due to the adverse effect of nausea. Repeat blood cultures on days 9 and 11 had no growth. The patient received amikacin and imipenem for a total of 4 weeks following line removal and was discharged home.
At the reference lab, the rapidly growing Mycobacterium species was identified as M. goodii by DNA sequencing. Susceptibility showed resistance to clarithromycin. Although the isolate was resistant to clarithromycin, it was susceptible to amikacin and had indeterminate susceptibility to imipenem. Repeat blood cultures collected 2 days after line removal and the start of empiric antibiotics were negative. The patient did not show up for a 1-month follow-up appointment.
DISCUSSION
M. goodii is a recently identified rapidly growing NTM from the M. smegmatis group. It was named in 1999 by Brown.1 Rapidly growing mycobacteria typically show mature growth within 7 days of incubation on solid agar.2 Previously reported cases of M. goodii infections involved cellulitis and osteomyelitis. Several cases with surgical device infection, such as “hardware,” pacemakers, and heart valves, have been reported.3 To date, no definite risk factor for this infection has been identified in the literature. There are previous case reports of central venous catheter–related infection with M. goodii in patients on chemotherapy resulting in nosocomial infections.4 The organism usually grows in 2 to 4 days on culture media, but species identification often takes 4 weeks for final results. Methods for NTM detection include culture and DNA sequencing.5
Due to the delay in identifying the organism, empiric therapy is recommended in rapidly growing NTM. Antibiotics recommended include sulfamethoxazole/trimethoprim and ethambutol followed by doxycycline and ciprofloxacin. For more serious infections, amikacin and meropenem have been used.4,6 Rapidly growing NTM are reported to be to susceptible to clarithromycin; however, M. goodii often has macrolide resistance, and monotherapy with azithromycin should be avoided. These bacteria can survive some decontamination and sterilization procedures, resulting in case reports after surgery in South America and the United States.4 Treatment should be based on susceptibility, and the duration of therapy is dictated by the clinical syndrome. Removal of contaminated devices, especially intravenous catheters, for source control is essential.7
References
- 1.Brown BA, Springer B, Steingrube VA, et al. Mycobacterium wolinskyi sp. nov. and Mycobacterium goodii sp. nov., two new rapidly growing species related to Mycobacterium smegmatis and associated with human wound infections: a cooperative study from the International Working Group on Mycobacterial Taxonomy. Int J Syst Bacteriol. 1999;49(4):1493–1511. doi: 10.1099/00207713-49-4-1493. [DOI] [PubMed] [Google Scholar]
- 2.Comba IY, Tabaja H, Almeida NEC, Fida M, Saleh OA.. Bloodstream infections with rapidly growing nontuberculous mycobacteria. J Clin Tuberc Other Mycobact Dis. 2021;25:100288. doi: 10.1016/j.jctube.2021.100288. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Shelton A, Giurgea L, Moshgriz M, Siegel M, Akselrod H.. A case of Mycobacterium goodii infection related to an indwelling catheter placed for the treatment of chronic symptoms attributed to Lyme disease. Infect Dis Rep. 2019;11(2):8108. doi: 10.4081/idr.2019.8108. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Salas NM, Klein N.. Mycobacterium goodii: an emerging nosocomial pathogen: a case report and review of the literature. Infect Dis Clin Pract (Baltim Md). 2017;25(2):62–65. doi: 10.1097/ipc.0000000000000428. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Liang Q, Shang Y, Huo F, et al. Assessment of current diagnostic algorithm for detection of mixed infection with Mycobacterium tuberculosis and nontuberculous mycobacteria. J Infect Public Health. 2020;13(12):1967–1971. doi: 10.1016/j.jiph.2020.03.017. [DOI] [PubMed] [Google Scholar]
- 6.Huang WC, Yu MC, Huang YW.. Identification and drug susceptibility testing for nontuberculous mycobacteria. J Formos Med Assoc. 2020;119(Suppl 1):S32–S41. doi: 10.1016/j.jfma.2020.05.002. [DOI] [PubMed] [Google Scholar]
- 7.Brown-Elliott BA, Nash KA, Wallace RJ Jr.. Antimicrobial susceptibility testing, drug resistance mechanisms, and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev. 2012;25(3):545–582. doi: 10.1128/cmr.05030-11. [DOI] [PMC free article] [PubMed] [Google Scholar]