自体脂肪移植术后非结核分枝杆菌感染的系统分析

Nontuberculous mycobacteria infection after autologous fat grafting:a systematic analysis

目的:系统分析自体脂肪移植术后非结核分枝杆菌(NTM)感染的患病及诊治情况。方法:全面检索国内外有关脂肪移植术后NTM感染的文献报道,依据制定的纳入及排除标准进行文献筛选;收集文献中每例入选患者的性别、年龄、术式、发病潜伏期、确诊时间、NTM种类、临床表现、治疗方案及时间、随访时间等。利用系统分析的方法对数据进行分类研究。正态分布计量资料以 ± s表示,偏态分布计量资料以 M( Q1, Q3)表示;计数资料以例(%)表示。 结果:共纳入31篇文献(72例患者),男1例,女71例,年龄(36.7±11.7)岁(范围21~67岁)。随访时间为12(6,36)个月(范围2个月~9年)。脂肪移植术后NTM感染部位:面部47例(65.3%),乳房15例(20.8%),腹部7例(9.7%),臀部6例(8.3%),四肢2例(2.8%)。其中,注射部位感染而吸脂部位未感染65例(90.3%),吸脂部位感染而注射部位未感染2例(2.8%),吸脂和注射部位均感染5例(6.9%)。NTM感染种类:脓肿分枝杆菌53例(73.6%),龟分枝杆菌10例(13.9%),偶发分枝杆菌7例(9.7%),设计分枝杆菌1例(1.4%),脓肿分枝杆菌+龟分枝杆菌1例(1.4%)。发病潜伏期为25(10,30)d (范围4 d~6个月)。确诊时间为120(68,195)d(范围30 d~2年)。69例(95.8%)患者行清创、引流、负压吸引等治疗,平均行3次以上清创术;所有患者均使用2种及以上抗生素治疗,克拉霉素、阿米卡星、环丙沙星、头孢西丁是最常用的抗生素。治疗时间为12(7,16)个月(范围2.5~18个月)。结论:自体脂肪移植术后NTM感染菌种以脓肿分枝杆菌、龟分枝杆菌、偶发分枝杆菌最多见,脂肪注射部位感染率明显高于吸脂部位。自体脂肪移植术后NTM感染诊断困难,误诊、误治率高。确诊后最常见的治疗策略是早期清创手术并辅以抗生素联合治疗。临床医生应该提高对NTM感染的认识,明确如何预防、诊断和治疗NTM感染。

ObjectiveTo systematically investigate the prevalence,diagnosis and treatment of nontuberculous mycobacteria(NTM)infection following autologous fat grafting.MethodsA comprehensive search and collection of domestic and international literature on NTM infection after autologous fat grafting was conducted based on established inclusion and exclusion criteria.The gender,age,surgical procedure,onset latency,time of diagnosis,NTM strain,clinical manifestations,treatment plan,and follow-up time of each selected patient were collected.Systematic analysis was performed on the collected data.The measurement data of normal distribution was expressed as Mean±SD,the data of skew distribution was expressed as M(Q 1,Q 3),count data was expressed as frequency and percentage.ResultsThe data of 72 patients from 31 studies were included in the analysis,with 1 male and 71 females,aged(36.7±11.7)years(ranging from 21 to 67 years).The follow-up period ranged from 2 months to 9 years,with a median time of 12(6,36)months.Infection sites after fat grafting included the face(65.3%,n=47),breast(20.8%,n=15),abdomen(9.7%,n=7),buttocks(8.3%,n=6),and limbs(2.8%,n=2).Among them,65 cases(90.3%)were infected at the injection site,2 cases(2.8%)were infected at the liposuction site,and 5 cases(6.9%)were infected at both the liposuction and injection sites.The identified strains of NTM were:M.abscessus in 53 cases(73.6%),M.chelonae in 10 cases(13.9%),M.fortuitum in 7 cases(9.7%),M.conceptionense in 1 case(1.4%),and mixed infection of M.abscessus/M.chelonae in 1 case(1.4%).The average latency period was 25(10,30)days,ranged from four days to six months.The time of diagnosis was approximately 120(68,195)days(ranged from 30 days to two years).Sixty-nine patients(95.8%)underwent debridement,drainage,and negative pressure aspiration,with an average of more than 3 times of debridement treatments.All patients were treated with two or more antibiotics.Clarithromycin,amikacin,ciprofloxacin,and cefoxitin were the most frequently used antibiotics.The mean duration of treatment was 12(7,16)months(ranged 2.5 to 18 months).ConclusionThe most common strains of NTM infection after autologous fat grafting were M.abscessus,M.chelonae,and M.fortuitum,with a higher infection rate observed at the fat injection site compared to the liposuction site.The most common treatment strategy for NTM after diagnosis was early debridement followed by combined antibiotic therapy.However,it is challenging to accurately diagnose NTM infections,leading to a high rate of misdiagnosis and mistreatment.Therefore,healthcare professionals should increase their awareness of NTM infections and acquire knowledge on how to prevent,diagnose,and treat them.