P51 – Mycobacterium Abscessus Infection in a Burn ICU Patient

Author(s):
Tanaz Vaghaiwalla, Shevonne Satahoo, Rolla Zarifa, Marc Dauer, James Davis, Doreann Dearmas, Nicholas Namias, Louis Pizano, Carl Schulman, Jackson Memorial Hospital/ University of Miami Miller School of Medicine

Background: Infection is the leading cause of death in burn patients. Historically, this was due to burn wound sepsis but pneumonia has now emerged as the most common source. In light of the increasing incidence of multi-drug resistant organisms, the description of rare infections is paramount to continuing the fight against deadly pathogens.

Hypothesis: We aim to describe the second case of non-tuberculous mycobacterium (NTM) reported in a burn patient. Difficulties in diagnosis and management will also be highlighted.

Methods: A 70 year-old Caucasian female, with a past medical history significant for Diabetes Mellitus Type 2, was transferred to our facility after a house fire. She had sustained a 28% TBSA flame burn to her neck, torso, and all 4 extremities. She underwent excision and grafting on hospital day (HD) 5 with multiple subsequent attempts at excision and grafting due to graft loss. On HD 14, she had a tracheostomy performed. Her hospital course was complicated by ongoing respiratory failure, renal injury and sepsis.

Results: Mycobacterium abscessus was found on blood cultures from central venous catheters and arterial line catheters; as well as on tracheal aspirate and bronchial alveolar lavage on HD 86. Imaging then revealed multiple pulmonary nodular densities with patchy ground-glass opacities. After multiple adjustments to the antibiotic regimen, she was placed on Tigecycline, Clarithromycin and Cefoxitin therapy. She remained on this regimen for almost 4 weeks. Her other infections included Acinetobacter baumannii treated with Tobramycin and Colistin, as well as Candida albicans for which she received Fluconazole. Ultimately, her clinical state worsened leading to withdrawal of care.

Conclusions: NTM sepsis is rare in burn patients with only one other case described in English language literature. Both cases reflect differences in diagnosis and management. This highlights the need to discuss rare infections in an attempt to broaden the clinician’s awareness of such pathogens, as well as to collaborate to form a consensus about their management.