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. 2022 Mar 16;9(4):ofac077.
doi: 10.1093/ofid/ofac077. eCollection 2022 Apr.

Treatment and Outcome of Culture-Confirmed Mycobacterium marinum Disease

Louise Hendrikx  1   2 , Colette L M van Hees  3 , Jurriaan E M de Steenwinkel  4 , Hannelore I Bax  4 , Tom Sprong  5 , Bert Mulder  6 , Arjan Jansz  7 , Arjanne van Griethuysen  8 , Ron Bosboom  9 , Annette Stemerding  10 , Marjolein Koetsier  11 , Marco van Coevorden  11 , Bas C Mourik  12 , Koen D Quint  13 , Alewijn Ott  14 , Dick van Soolingen  15 , Saskia Kuipers  1 , Reinout van Crevel  2 , Jakko van Ingen  1
Affiliations

Treatment and Outcome of Culture-Confirmed Mycobacterium marinum Disease

Louise Hendrikx et al. Open Forum Infect Dis. .

Abstract

Background: Mycobacterium marinum is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment consists of multiple antibiotics, sometimes combined with surgical debridement. There is little evidence for the choice of antibiotics, the duration of treatment, and the role of susceptibility testing.

Methods: We performed a retrospective cohort study of culture-confirmed M. marinum infections in the Netherlands in the 2011-2018 period. Clinical characteristics, in vitro susceptibility, extent of disease, treatment regimens, and outcomes were analyzed. Incidence was assessed from laboratory databases.

Results: Forty cases of M. marinum infection could be studied. Antibiotic treatment cured 36/40 patients (90%) after a mean treatment duration of 25 weeks. Failure/relapse occurred in 3 patients, and 1 patient was lost to follow-up. Antibiotic treatment consisted of monotherapy in 35% and 2-drug therapy in 63%. Final treatment contained mostly ethambutol-macrolide combinations (35%). Eleven patients (28%) received additional surgery. We recorded high rates of in vitro resistance to tetracyclines (36% of isolates). Tetracycline resistance seemed correlated with poor response to tetracycline monotherapy. The annual incidence rate was 0.15/100 000/year during the study period.

Conclusions: Prolonged and susceptibility-guided treatment results in a 90% cure rate in M. marinum disease. Two-drug regimens of ethambutol and a macrolide are effective for moderately severe infections. Tetracycline monotherapy in limited disease should be used vigilantly, preferably with proven in vitro susceptibility.

Keywords: Mycobacterium marinum; doxycycline; epidemiology; fish tank finger; nontuberculous mycobacteria.

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Figures

Figure 1.
Figure 1.
Doxycycline minimum inhibitory concentration distribution in 28 M. marinum isolates. The line represents the breakpoint to define resistance according to CLSI document M24-A2, relevant to the study period. Abbreviations: CLSI, Clinical and Laboratory Standards Institute; MIC, minimum inhibitory concentration.
See this image and copyright information in PMC

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