Post-procedural Wound Infections by Mycobacterium fortuitum: A Series of Seven Cases From Eastern India

BackgroundRapidly growing nontuberculous mycobacteria (NTM), particularly Mycobacterium fortuitum, are increasingly recognized as causes of chronic post-procedural skin and soft tissue infections.However, delayed clinical suspicion and limited microbiological investigations often result in underdiagnosis, especially in resourcelimited settings.We describe the clinical, microbiological, and therapeutic characteristics of a series of patients with post-procedural M. fortuitum infection from Eastern India. MethodsThis cross-sectional observational study was conducted at a tertiary care teaching hospital in Eastern India between September 2024 and August 2025.Seven patients with culture-confirmed M. fortuitum infection were subsequently described as a case series.Clinical specimens were processed for Ziehl-Neelsen staining, routine bacterial culture, and mycobacterial culture using the BacT/ALERT MP liquid culture system and Middlebrook medium.Species identification was done using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).Clinical presentation, microbiological findings, treatment, and outcomes were analysed descriptively. ResultsMycobacterium fortuitum was isolated from seven of the clinically suspected cases.The mean patient age was 39 years, and six (85.7%) were female.Five patients (71.4%) had undergone their primary procedure at peripheral nursing homes.Patients presented with chronic non-healing wounds, persistent serous or seropurulent discharge, delayed wound healing, and poor response to conventional antibacterial therapy.Direct Ziehl-Neelsen staining was positive in two (28.6%)cases, whereas all isolates were recovered by BacT/ALERT MP liquid culture within 4-11 days and identified as M. fortuitum by MALDI-TOF MS.All patients received prolonged combination antimicrobial therapy, with one patient requiring surgical debridement.Complete clinical healing was achieved in all cases. ConclusionsMycobacterium fortuitum is an important but frequently overlooked cause of chronic post-procedural wound infections.Isolation of M. fortuitum in seven clinically suspected NTM wound infections highlights the importance of maintaining a high index of clinical suspicion in patients with persistent non-healing postoperative wounds, particularly when routine bacterial cultures are negative or there is poor response to conventional antibacterial therapy.Early mycobacterial culture with species-level identification is essential for timely diagnosis and appropriate management.