Akademik Veri Yönetim Sistemi
35th Congress of the European Society of Clinical Microbiology and Infectious Diseases, Vienna, Avusturya, 11 - 15 Nisan 2025, cilt.4056, sa.4671, ss.4671, (Özet Bildiri)
Background
Tuberculosis (TB) remains a significant global health threat; however, prosthetic joint infections (PJIs) attributable to Mycobacterium tubercu-
losis are uncommon. A lack of clinical suspicion often leads to diagnostic delays, unnecessary long-term antibiotic treatments, and repeated
surgical interventions. This study aims to enhance awareness of mycobacterial infections in the differential diagnosis of PJIs, particularly in
endemic regions.
Case(s) description
We conducted a retrospective analysis of patients diagnosed with PJIs who had a positive culture for Mycobacterium tuberculosis in osteoartic-
ular samples at a university hospital in Izmir, Turkey, from 2000 to 2024. We examined clinical features and treatment outcomes.Between 2000
and 2024, Mycobacterium tuberculosis was cultured from 29 osteoarticular samples, with 10 patients meeting the criteria for PJIs. The cohort
comprised 8 females, with a median age of 66.5 years (range: 38-88 years). Notably, none of the patients had a prior history of tuberculosis. Of
the six patients evaluated with a tuberculin skin test, four tested positive. The affected joints included the knee (6 patients) and hip (4 patients).
The median interval from prosthesis implantation to infection onset was 30 months (range: 12-108 months). Sensitivity testing revealed that
8 patients had Mycobacterium tuberculosis strains sensitive to rifampicin (R), isoniazid (I), ethambutol (E), and streptomycin (S). One patient
exhibited resistance to isoniazid and streptomycin, while another was resistant only to isoniazid. Antituberculosis treatment regimens and sur-
gical interventions are detailed in the accompanying table. Additionally, other microorganisms were identified during concurrent cultures in two
patients, including Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli. Pathological evaluations indicated necrotizing
granulomatous infections in 6 cases and granulomatous infections in 4 cases. The standard antituberculosis treatment duration was typically 12
months. All patients were successfully treated with a two-stage revision and extended antituberculosis therapy.
Discussion
Mycobacterium tuberculosis should be included in the differential diagnosis of PJIs in endemic areas, particularly when routine bacterial cultures
yield negative results and the response to antibiotic therapy is suboptimal.