A Case Report of Refractory Mycobacterium wolinskyi Knee Infection in a Metabolic Syndrome Patient: mNGS Diagnosis and Pharmacist-Guided Therapy

Min Shao,1,* Lijia Ni,2,3,* Liang Jiang,4 Jingyi Hou,4 Sicheng Xu,4 Yin Lin,5 Xiaoying Xie6 1Department of Pharmacy, Liwan Central Hospital of Guangzhou, Guangzhou, 510000, People’s Republic of China; 2Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People’s Republic of China; 3Institution of Antibiotic, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People’s Republic of China; 4Department of Orthopedic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People’s Republic of China; 5Department of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People’s Republic of China; 6Department of Clinical Laboratory, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518106, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaoying Xie, Email [email protected] Yin Lin, Email [email protected]: Mycobacterium wolinskyi (M. wolinskyi), which is a rare rapidly growing mycobacterium (RGM), and the infections it causes are predominantly linked to surgery or invasive procedures. We detailed a case of refractory surgical site infection (SSI) caused by M. wolinskyi. The causative pathogen was identified by metagenomic next-generation sequencing (mNGS) analysis, 16S rRNA and rpoB gene sequencing. What renders this case particularly remarkable is the complexity introduced by a series of antibiotic-induced adverse effects, which seem to be deeply intertwined with the patient’s underlying metabolic syndrome. With the meticulous pharmaceutical guidance provided by the clinical pharmacist, the patient experienced a substantial improvement in his knee joint infection.Keywords: Mycobacterium wolinskyi, surgical site infection, metabolic syndrome, mNGS