Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA

Emerg Infect Dis. 2019 Jun;25(6):1075-1083. doi: 10.3201/eid2406.181041.


Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients required multiple antimicrobial agents along with aggressive surgical treatment; 13 of 14 patients ultimately achieved cure. Four patients required amputation to control the infection. Half these patients were immunosuppressed by medications or other medical illness when they sought care at the referral center. Six cases involved joint prostheses; all ultimately required hardware removal and placement of an antimicrobial spacer for eradication of infection. Our findings highlight the importance of vigilance for nontuberculous mycobacterial musculoskeletal infection, particularly in patients who are immunosuppressed or have a history of musculoskeletal surgery.

Keywords: Colorado; Mycobacterium; United States; antimicrobial resistance; infectious arthritis; musculoskeletal diseases; nontuberculous mycobacteria; osteomyelitis; prosthesis-related infections; tuberculosis and other mycobacteria.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / pharmacology
  • Antitubercular Agents / therapeutic use
  • Colorado / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / diagnosis
  • Musculoskeletal Diseases / drug therapy
  • Musculoskeletal Diseases / epidemiology*
  • Musculoskeletal Diseases / microbiology*
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Mycobacterium Infections, Nontuberculous / drug therapy
  • Mycobacterium Infections, Nontuberculous / epidemiology*
  • Mycobacterium Infections, Nontuberculous / microbiology*
  • Nontuberculous Mycobacteria*
  • Prosthesis-Related Infections / microbiology
  • Public Health Surveillance
  • Retrospective Studies
  • Symptom Assessment
  • Tertiary Care Centers*
  • Young Adult


  • Antitubercular Agents