Atypical mycobacterial infection at laparoscopic port site: Report of two cases indicating possibility of multi drug resistant strains in north-east India and review of literature.

Atypical mycobacterial infections (AMIs), also known as nontuberculous mycobacterial (NTM) infections, are rare but important causes of postoperative port site infections following laparoscopic surgery. These infections are difficult to treat, often result in prolonged or recurrent illness, and typically respond poorly to conventional antibiotics. Although they may clinically mimic tuberculosis, they are resistant to many first-line antitubercular medications. Currently, there are no well-defined care recommendations for NTM associated port site infections. Therefore, we present two cases of delayed port site infection following laparoscopic surgery, both of which posed significant diagnostic challenges due to delayed presentation and demonstrated a possible partial/complete clinical resistance to commonly used antibiotics, including clarithromycin and ciprofloxacin. Both the patients were treated with prolonged antibiotic therapy (amikacin, linezolid, azithromycin etc. and one case required clofazimine), along surgical debridement of the infected tissues. Owing to the paucity of literature on the management of NTM port site infections, we also systematically reviewed all reported cases of laparoscopic surgery associated NTM port site infections from India.