Background The objective of our study is to describe the clinical presentation, management, and outcome of a large cohort with NTM hand infection. Methods We reviewed the medical records of all adults (≥18 years) managed at the Mayo Clinic (Rochester, MN) for NTM hand infection between 1998-2018. Results Our cohort included 81 patients. The median age was 61.3 (interquartile-range (IQR) 51.7, 69.6) years; 39.5% were immunocompromised, and 67.9% reported a triggering exposure preceding infection. Infection was deep in 64.2% and disseminated in 3.7%. Up to 16.0% received intralesional steroids due to misdiagnosis with an inflammatory process. Immunocompromised patients had deeper infection, and fewer reports of a triggering exposure. M. marinum, M. avium complex (MAC), and M. chelonae/abscessus complex (MCAC) were the most common species. The median antibiotic duration was 6.1 (IQR 4.6, 9.9) months. Deep infection and infection with species other than M. marinum were associated with using a greater number of antibiotics for combination therapy and an extended duration of treatment. Immunosuppression was also associated with longer courses of antibiotic therapy. Surgery was performed in 86.5%, and 32.4% required multiple procedures. Ten patients, mostly with superficial infections, were treated with antibiotics alone. The 5-year cumulative rate of treatment failure was 30.3% (95% confidence interval (CI) 20.9%-44.0%). Immunosuppression and intralesional steroid use were risk factors for failure. Conclusion Treatment of NTM hand infection usually requires surgery and antibiotics, but antibiotics alone may occasionally be attempted in select cases. Immunosuppression and intralesional steroids are risk factors for treatment failure.

中文翻译：

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对非结核分枝杆菌手部感染的两个十年的见解

背景 我们研究的目的是描述大量 NTM 手部感染患者的临床表现、治疗和结果。方法 我们回顾了 1998 年至 2018 年间在梅奥诊所（明尼苏达州罗彻斯特）治疗 NTM 手部感染的所有成年人（≥18 岁）的医疗记录。结果 我们的队列包括 81 名患者。中位年龄为 61.3（四分位距 (IQR) 51.7, 69.6）岁； 39.5% 的人免疫功能低下，67.9% 的人报告在感染前曾接触过触发因素。 64.2% 为深度感染，3.7% 为播散性感染。高达 16.0% 的患者由于炎症过程的误诊而接受了病灶内类固醇治疗。免疫功能低下的患者感染较深，触发暴露的报道较少。海分枝杆菌、鸟分枝杆菌复合体 (MAC) 和龟分枝杆菌/脓肿复合体 (MCAC) 是最常见的物种。中位抗生素使用时间为 6.1 (IQR 4.6, 9.9) 个月。深部感染和海分枝杆菌以外的物种感染与使用更多抗生素进行联合治疗和延长治疗时间有关。免疫抑制也与较长疗程的抗生素治疗有关。 86.5% 进行了手术，32.4% 需要多次手术。十名患者（大多患有浅表感染）仅接受抗生素治疗。 5年累积治疗失败率为30.3%（95%置信区间（CI）20.9%-44.0%）。免疫抑制和病灶内类固醇的使用是失败的危险因素。结论 NTM 手部感染的治疗通常需要手术和抗生素，但在某些病例中偶尔可以尝试单独使用抗生素。免疫抑制和病灶内类固醇是治疗失败的危险因素。