P112

The incidence of skin and soft tissue infections (SSTIs) caused by non-tuberculous mycobacteria (NTM) is increasing. NTM SSTI antibiotic treatment is challenging because of its long duration and toxicity. Little is known about the clinical characteristics, treatment and outcome of NTM SSTI. We describe the clinical management of adult NTM SSTI patients in two Dutch tertiary referral institutes, using electronic patient data from patients diagnosed between 2017 and 2023. We identified 55 NTM SSTI patients of which 62% were male, with a median age of 62 years (IQR 52-73). Prior to presentation, 56% of patients had received immunosuppressive medication. Corticosteroids were the most common medication, followed by TNF-α inhibitors. Mycobacterium chelonae (29%) was most frequently isolated, followed by Mycobacterium avium complex (15%) and Mycobacterium marinum (15%). Disseminated disease was exclusively observed in immunocompromised patients. Antibiotic treatment was given for a median of 28 weeks (IQR 19 - 33) in immunocompetent patients, while this was 42 weeks (IQR 35 - 52) in the context of immunosuppression. Side effects led to treatment regimen changes in 73% of cases, with gastro-intestinal complaints and ototoxicity being the most reported. Surgical debridement was performed in 53% of patients. All but four patients, who were all immunocompromised, achieved clinical cure. In conclusion, the use of immunosuppressive medication is a major risk factor for NTM SSTI. The multidrug antibiotic regimens commonly lead to side effects. Adjuvant surgical treatment to reduce the mycobacterial load could be an additional strategy to achieve clinical cure sooner.