Mycobacterial soft tissue infections in North Queensland

Background: Mycobacterial soft tissue infections are a heterogeneous group of infections that usually require a variety of therapeutic methods for cure. North Queensland has an environment, which predisposes to several such infections. The aim of this study was to assess the incidence and epidemiology of mycobacterial soft tissue infections in North Queensland and to review surgical and non-surgical interventions in these conditions. Methods: This study was a retrospective review of all patients with a proven mycobacterial soft tissue infection, seen between 1997 and 2005 in a tertiary referral centre in North Queensland. Results: In total, 34 patients were identified. The most common causative organisms were Mycobacterium fortuitum (44%), M. ulcerans (17.6%) and M. abscessus (11.8%). The risk factors identified were the male sex, lower-limb involvement and preceding trauma including surgery. Twenty-four (70.6%) patients had surgical excision or debridement with a variety of adjuvant antimicrobial therapies. There were eight (23.5%) local recurrences. Conclusion: The optimal management of soft tissue mycobacterial infections includes early microbiological identification based on tissue biopsy, appropriate combination antimicrobial therapy and early wide surgical excision where appropriate. North Queensland has a unique environment, which may predispose to these infections. An awareness of this is essential to surgical practice in the region.