Mycobacterium abscessus Urinary Tract Infection Associated with Urinary Catheter Use: A Case Report

Mycobacterium abscessus Urinary Tract Infection Associated with Urinary Catheter Use: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Mycobacterium abscessus Urinary Tract Infection Associated with Urinary Catheter Use: A Case Report Majed Alanazi, Naif Alsaber, Nasser Alharbi, Munirah Alissa, Majed Alaskar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5731049/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Urinary tract infections (UTIs) are a common health issue, especially among the elderly. While most UTIs are caused by typical bacterial pathogens, infections with atypical organisms like Mycobacterium abscessus, a non-tuberculous mycobacterium (NTM), are exceedingly rare. This case report details one such case of a 78-year-old woman with a complex medical history who developed a persistent UTI due to M. abscessus associated with urinary catheter use. Despite multiple courses of antibiotics, her symptomatology persisted, leading to the isolation of M. abscessus via acid-fast bacilli (AFB) culture. This case makes evident the challenges associated with diagnosing and managing NTM UTIs, especially given the organism’s resistance to standard treatments and the patient’s multiple comorbidities. A comprehensive review of relevant literature is provided, further delineating the rarity of genitourinary M. abscessus infections and the need for specialized diagnostic and therapeutic approaches. Mycobacterium abscessus Urinary tract infection Catheter-associated infection Multidrug resistance Non-tuberculous mycobacteria Introduction Non-tuberculous mycobacteria (NTM) are uncommon pathogens commonly encountered in immunocompromised hosts and only rarely in immunocompetent ones. Among rapidly growing mycobacteria (RGM), Mycobacterium abscessus (M. abscessus) is considered one of the more pathogenic species, commonly afflicting the lungs, skin, and soft tissues. However, infections involving the urinary tract are exceedingly rare and present profound diagnostic and therapeutic challenges due to M. abscessus ’s rarity and multidrug resistance. This case report complements the limited literature on M. abscessus UTIs. 1 – 5 Therefore, it becomes paramount that clinical, diagnostic, and therapeutic complexities involved be readily apparent for early detection and treatment of such cases. Case Presentation A 78-year-old woman who is known to have type 2 diabetes mellitus, dyslipidemia, hypertension, and ischemic heart disease presented with urinary retention following a surgical procedure. The post-operative course was complicated by the need for urinary catheterization, leading to intermittent home catheterization. Her initial presentation to the emergency department included dysuria, abdominal pain, and persistent urinary retention requiring Foley catheter placement. Initial urinalysis (UA) and labs were unremarkable. Four days later, she presented again to the emergency department with worsening dysuria and was subsequently admitted by the internal medicine team for further workup and management. Urine culture isolated Escherichia coli (E. coli) that is sensitive to nitrofurantoin, ceftriaxone, amoxicillin-clavulanic acid, and gentamicin. She received three days of intravenous ceftriaxone 1g daily and was discharged on amoxicillin-clavulanic acid to complete the antibiotic duration. The patient's symptoms improved significantly. During follow-up at the urology clinic two weeks later, UA and urine culture were negative, and she was prescribed trospium chloride for symptomatic management. However, three months later, she developed another UTI with E. coli showing a notably different resistance pattern. The culture was sensitive to trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, and ceftriaxone but resistant to nitrofurantoin and ampicillin. She completed a 7-day course of oral TMP-SMX and was subsequently started on prophylactic fosfomycin 3 grams weekly by the infectious diseases (ID) team. Despite prophylaxis, the patient's symptoms persisted for three months. She was evaluated at multiple specialty clinics, including urogynecology, where cultures again revealed E. coli with a similar sensitivity pattern, and she was started on another course of TMP-SMX. One month later, her symptoms worsened significantly, the patient presented with severe dysuria and urge incontinence, and was admitted for further investigations. Urine culture revealed Mycobacterium abscessus and blood cultures were positive for acid-fast bacilli, indicating systemic involvement. She was started on amikacin 750 mg intravenous (IV) daily, clarithromycin 500 mg orally twice daily, and imipenem-cilastatin 1g IV every 8 hours. She was discharged on outpatient parenteral antimicrobial therapy with continued imipenem-cilastatin. Notably, throughout her prolonged course, the patient remained afebrile with no significant elevation in inflammatory markers, with the diagnosis primarily driven by persistent symptoms and specialized culture results. Susceptibility results revealed sensitivity to amikacin, doxycycline, cefoxitin, moxifloxacin, and isoniazid, while ciprofloxacin and amoxicillin-clavulanic acid were intermediately sensitive. Resistance was noted against TMP-SMX, imipenem, and clarithromycin. The treatment regimen was adjusted to include isoniazid and doxycycline for 2 months, in addition to pyridoxine. A follow-up appointment was scheduled to monitor clinical improvement and assess liver enzyme levels. Discussion Diagnosing M. abscessus infections requires an exceptionally high level of suspicion. This is especially pronounced in individuals with recurrent UTIs unresponsive to conventional UTI antibiotics, especially in the presence of associated risk factors. M. abscessus forms biofilms on medical devices such as catheters. Thus, furthering the risk of catheter-associated infections and multi-drug resistance due to the resistant neomembrane imparted by such structures and inertial forces to not be swept away with the urinary stream. 6 A review of risk factors associated with NTM identified chronic kidney disease and type-II diabetes as particularly prevalent risk factors among urogenital NTM infections. 3 The patient’s prolonged catheter use and recurrent antibiotic exposure may have contributed to her susceptibility to NTM colonization and infection rather than it being a protracted, undetected course. Moreover, urge and neurogenic cystopahties are potential contributors to a slower urinary stream that may make our patient susceptible to UTIs. Standard urine cultures often fail to detect NTMs, and alternative diagnostic methods, such as AFB cultures or molecular sequencing, become requisite in diagnosing such cases. M. abscessus is one of the most drug-resistant organisms with a multifarious and plastic profile of resisted drugs like fluoroquinolones, rifampin, imipenem, and aminoglycosides, either partially or completely, depending on the characteristics of expressed genes. 7 Due to M. abscessus ’s notorious multidrug-resistant profile, empirical treatment should ideally involve a multi-drug regimen over extended periods. M. abscessus is resistant to standard antitubercular drugs (e.g., isoniazid, rifampicin, pyrazinamide); however, a study in Taiwan reported a 93%-96% susceptibility rate to amikacin, 12%-29% to imipenem, and 53%-93% to clarithromycin. 8 Despite deriving most of the data from pulmonary infections, such observations have guided the empirical therapy of NTM infections. In our case, a multidisciplinary approach culminated in choosing imipenem, amikacin, and clarithromycin to curtail M. abscessus ’s progression pending culture sensitivities. The literature surrounding M. abscessus UTIs is limited, reflecting the rarity of the infection and the challenges it presents. Conclusion This case emphasizes the potential for rare but difficult to diagnose UTIs that are caused by NTMs. Early recognition and appropriate treatment can lead to significant symptoms improvement, minimize disease course and reduce numbers of admission to hospital. Clinicians must maintain a high level of awareness of NTMs as potential causes of refractory UTIs. Abbreviations Abbreviation Definition UTI Urinary Tract Infection NTM Non-Tuberculous Mycobacterium AFB Acid-Fast Bacilli RGM Rapidly Growing Mycobacteria M. abscessus Mycobacterium abscessus UA Urinalysis E. coli Escherichia coli TMP-SMX Trimethoprim-Sulfamethoxazole ID Infectious Diseases IV Intravenous Declarations Ethics approval and consent to participate: The study is retrospective and is compliant with the National Committee Bioethics (NCBE), Saudi Health Information Exchange (SeHe) policies, and Saudi Data and Artificial Intelligence Authority (SDAIA); as is detailed in Article 14.1 of the NCBE's Implementing Regulations of the Law of Ethics of Research on Living Creatures. The report does not contain patient-specific data. All data have been de-identified to ensure total anonymity. The study has been approved by the Institutional Review Board at King Abdullah International Medical Research Center (KAIMRC) (Approval no. #0000096924) (Study number: NRR24/089/12). Consent for publication: The study was approved by the Institutional Review Board at King Abdullah International Medical Research Center (KAIMRC; Approval No. #0000096924). The report does not contain patient-specific data; all information has been de-identified to ensure complete anonymity. Moreover, informed, explicit verbal and written consent was obtained to report the case. No incentives or compensation were offered to conduct the present report. Availability of data and materials: Not applicable. Competing interests: The authors declare that they have no competing interests. Funding: The authors do not have any conflict of funding to declare. Authors' contribution: M.A. conceptualized the study, wrote the case description, and reviewed the final manuscript. N.S.A. reviewed and wrote the background and introduction. N.A. contributed to the discussion and clinical implications. M.M.A. also contributed to the case description, abstract writing, and manuscript editing and took the initiative in the submission process. M.A.A. wrote the abstract and contributed to the discussion. All authors reviewed the manuscript. Acknowledgement: This work was supported by King Abdulaziz Medical City, Ministry of National Guard and Health Affairs, Riyadh, Saudi Arabia. References Abolghasemi S, Sali S, Aghdam AM, Shahrbaf MA. Anti-tuberculosis induced Stevens-Johnson syndrome due to misdiagnosis of Mycobacterium abscessus urinary tract infection as tuberculosis. Iranian Journal of Kidney Diseases 2021; 15 (3): 235. Al-Mashdali AF, Ali GA, Taha NM, Goravey W, Omrani AS. Mycobacterium abscessus urinary tract infection in an immunocompetent host: A case report and literature review. IDCases 2022; 29 : e01538. Huang CT, Chen CY, Chen HY, et al. Genitourinary infections caused by nontuberculous mycobacteria at a university hospital in Taiwan, 1996–2008. Clinical Microbiology and Infection 2010; 16 (10): 1585-90. Laudelino JS, Farias Filho FT, Costa AFP, Santos VM. Mycobacterium abscessus urinary tract infection: case report. Brazilian Journal of Nephrology 2020; 42 (1): 124-6. Mehanni S, Joseph K, Casanas B, Greene J. Mycobacterium Abscessus Granulomatous Cystitis in a Patient With Superficial Bladder Cancer. Infectious Diseases in Clinical Practice 2014; 22 (2): 116-7. Qvist T, Eickhardt S, Kragh KN, et al. Chronic pulmonary disease with Mycobacterium abscessus complex is a biofilm infection. European Respiratory Journal 2015; 46 (6): 1823-6. Johansen MD, Herrmann J-L, Kremer L. Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus. Nature Reviews Microbiology 2020; 18 (7): 392-407. Weng Y-W, Huang C-K, Sy C-L, Wu K-S, Tsai H-C, Lee SS-J. Treatment for Mycobacterium abscessus complex–lung disease. Journal of the Formosan Medical Association 2020; 119 : S58-S66. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5731049","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":404158679,"identity":"d1389ec2-9a87-40a1-b9f2-16a98ddd553a","order_by":0,"name":"Majed Alanazi","email":"","orcid":"","institution":"Department of Internal Medicine, King Abdulaziz Medical City, Ministry of National Guard and Health Affairs","correspondingAuthor":false,"prefix":"","firstName":"Majed","middleName":"","lastName":"Alanazi","suffix":""},{"id":404158680,"identity":"0cf86e3d-4359-480d-b448-e81e2e546218","order_by":1,"name":"Naif Alsaber","email":"","orcid":"","institution":"Department of Neurology, King Abdulaziz Medical City, Ministry of National Guard and Health Affairs","correspondingAuthor":false,"prefix":"","firstName":"Naif","middleName":"","lastName":"Alsaber","suffix":""},{"id":404158681,"identity":"9e81f646-df7a-43bc-b183-1b9ee64dd13f","order_by":2,"name":"Nasser Alharbi","email":"","orcid":"","institution":"Division of Physical Medicine and Rehabilitation, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs","correspondingAuthor":false,"prefix":"","firstName":"Nasser","middleName":"","lastName":"Alharbi","suffix":""},{"id":404158682,"identity":"42c3da86-7e88-4523-a91c-75aeee1aceac","order_by":3,"name":"Munirah Alissa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYBACgwMMDBDEwNwAEpADEQce4NFiidDCCNZiDNaSgEeL/QEwhdCSCCbxaTG7kXvwcEXNnWgG9oOND3/8sUufH3b4IdAWOzndBlxa8hIOnjn2LLeBJ7HZmLctOXfj7TQDoJZkY7MDuLTkGBxsYDuc28CQ2CbN2MCcu3F2AkjLgcRtOLQYgLX8A2rhf9j+88ef+nTD2ekfCGtpbANqkUhsY+BhO5wgL51DwJYzb4Ba+g7ntkk8bJbmbTtuuEE6p+BAggFuvxgczzH+2PDtcG4/f/LBjz/+VMvLz07f/OFDhZ0cLi1wwAY3BKzSgIByFCDfQIrqUTAKRsEoGAkAAOPCcDR43WJLAAAAAElFTkSuQmCC","orcid":"","institution":"Princess Nourah bint Abdulrahman University","correspondingAuthor":true,"prefix":"","firstName":"Munirah","middleName":"","lastName":"Alissa","suffix":""},{"id":404158683,"identity":"69d81a86-ea13-40c0-990d-b730bf8917ea","order_by":4,"name":"Majed Alaskar","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Majed","middleName":"","lastName":"Alaskar","suffix":""}],"badges":[],"createdAt":"2024-12-29 17:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5731049/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5731049/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104082768,"identity":"d7b57586-2e61-41a7-b5c4-638267c6977b","added_by":"auto","created_at":"2026-03-06 14:42:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":272221,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5731049/v1/ab0e9d8a-50b4-49ec-a933-f580c11ec233.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mycobacterium abscessus Urinary Tract Infection Associated with Urinary Catheter Use: A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNon-tuberculous mycobacteria (NTM) are uncommon pathogens commonly encountered in immunocompromised hosts and only rarely in immunocompetent ones. Among rapidly growing mycobacteria (RGM), \u003cem\u003eMycobacterium abscessus (M. abscessus)\u003c/em\u003e is considered one of the more pathogenic species, commonly afflicting the lungs, skin, and soft tissues. However, infections involving the urinary tract are exceedingly rare and present profound diagnostic and therapeutic challenges due to \u003cem\u003eM. abscessus\u003c/em\u003e\u0026rsquo;s rarity and multidrug resistance. This case report complements the limited literature on \u003cem\u003eM. abscessus\u003c/em\u003e UTIs.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Therefore, it becomes paramount that clinical, diagnostic, and therapeutic complexities involved be readily apparent for early detection and treatment of such cases.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 78-year-old woman who is known to have type 2 diabetes mellitus, dyslipidemia, hypertension, and ischemic heart disease presented with urinary retention following a surgical procedure. The post-operative course was complicated by the need for urinary catheterization, leading to intermittent home catheterization. Her initial presentation to the emergency department included dysuria, abdominal pain, and persistent urinary retention requiring Foley catheter placement. Initial urinalysis (UA) and labs were unremarkable. Four days later, she presented again to the emergency department with worsening dysuria and was subsequently admitted by the internal medicine team for further workup and management. Urine culture isolated Escherichia coli (E. coli) that is sensitive to nitrofurantoin, ceftriaxone, amoxicillin-clavulanic acid, and gentamicin. She received three days of intravenous ceftriaxone 1g daily and was discharged on amoxicillin-clavulanic acid to complete the antibiotic duration. The patient's symptoms improved significantly. During follow-up at the urology clinic two weeks later, UA and urine culture were negative, and she was prescribed trospium chloride for symptomatic management. However, three months later, she developed another UTI with E. coli showing a notably different resistance pattern. The culture was sensitive to trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, and ceftriaxone but resistant to nitrofurantoin and ampicillin. She completed a 7-day course of oral TMP-SMX and was subsequently started on prophylactic fosfomycin 3 grams weekly by the infectious diseases (ID) team.\u003c/p\u003e \u003cp\u003eDespite prophylaxis, the patient's symptoms persisted for three months. She was evaluated at multiple specialty clinics, including urogynecology, where cultures again revealed E. coli with a similar sensitivity pattern, and she was started on another course of TMP-SMX. One month later, her symptoms worsened significantly, the patient presented with severe dysuria and urge incontinence, and was admitted for further investigations. Urine culture revealed Mycobacterium abscessus and blood cultures were positive for acid-fast bacilli, indicating systemic involvement. She was started on amikacin 750 mg intravenous (IV) daily, clarithromycin 500 mg orally twice daily, and imipenem-cilastatin 1g IV every 8 hours. She was discharged on outpatient parenteral antimicrobial therapy with continued imipenem-cilastatin. Notably, throughout her prolonged course, the patient remained afebrile with no significant elevation in inflammatory markers, with the diagnosis primarily driven by persistent symptoms and specialized culture results.\u003c/p\u003e \u003cp\u003eSusceptibility results revealed sensitivity to amikacin, doxycycline, cefoxitin, moxifloxacin, and isoniazid, while ciprofloxacin and amoxicillin-clavulanic acid were intermediately sensitive. Resistance was noted against TMP-SMX, imipenem, and clarithromycin.\u003c/p\u003e \u003cp\u003eThe treatment regimen was adjusted to include isoniazid and doxycycline for 2 months, in addition to pyridoxine. A follow-up appointment was scheduled to monitor clinical improvement and assess liver enzyme levels.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDiagnosing \u003cem\u003eM. abscessus\u003c/em\u003e infections requires an exceptionally high level of suspicion. This is especially pronounced in individuals with recurrent UTIs unresponsive to conventional UTI antibiotics, especially in the presence of associated risk factors. \u003cem\u003eM. abscessus\u003c/em\u003e forms biofilms on medical devices such as catheters. Thus, furthering the risk of catheter-associated infections and multi-drug resistance due to the resistant neomembrane imparted by such structures and inertial forces to not be swept away with the urinary stream.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e A review of risk factors associated with NTM identified chronic kidney disease and type-II diabetes as particularly prevalent risk factors among urogenital NTM infections.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The patient\u0026rsquo;s prolonged catheter use and recurrent antibiotic exposure may have contributed to her susceptibility to NTM colonization and infection rather than it being a protracted, undetected course. Moreover, urge and neurogenic cystopahties are potential contributors to a slower urinary stream that may make our patient susceptible to UTIs. Standard urine cultures often fail to detect NTMs, and alternative diagnostic methods, such as AFB cultures or molecular sequencing, become requisite in diagnosing such cases.\u003c/p\u003e \u003cp\u003e \u003cem\u003eM. abscessus\u003c/em\u003e is one of the most drug-resistant organisms with a multifarious and plastic profile of resisted drugs like fluoroquinolones, rifampin, imipenem, and aminoglycosides, either partially or completely, depending on the characteristics of expressed genes.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Due to \u003cem\u003eM. abscessus\u003c/em\u003e\u0026rsquo;s notorious multidrug-resistant profile, empirical treatment should ideally involve a multi-drug regimen over extended periods. \u003cem\u003eM. abscessus\u003c/em\u003e is resistant to standard antitubercular drugs (e.g., isoniazid, rifampicin, pyrazinamide); however, a study in Taiwan reported a 93%-96% susceptibility rate to amikacin, 12%-29% to imipenem, and 53%-93% to clarithromycin.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Despite deriving most of the data from pulmonary infections, such observations have guided the empirical therapy of NTM infections. In our case, a multidisciplinary approach culminated in choosing imipenem, amikacin, and clarithromycin to curtail \u003cem\u003eM. abscessus\u003c/em\u003e\u0026rsquo;s progression pending culture sensitivities. The literature surrounding \u003cem\u003eM. abscessus\u003c/em\u003e UTIs is limited, reflecting the rarity of the infection and the challenges it presents.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case emphasizes the potential for rare but difficult to diagnose UTIs that are caused by NTMs. Early recognition and appropriate treatment can lead to significant symptoms improvement, minimize disease course and reduce numbers of admission to hospital. Clinicians must maintain a high level of awareness of NTMs as potential causes of refractory UTIs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eAbbreviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eDefinition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eUTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eUrinary Tract Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eNTM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eNon-Tuberculous Mycobacterium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eAFB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eAcid-Fast Bacilli\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eRGM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eRapidly Growing Mycobacteria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eM. abscessus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eMycobacterium abscessus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eUA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eUrinalysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eE. coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eEscherichia coli\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eTMP-SMX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eTrimethoprim-Sulfamethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eInfectious Diseases\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.3766%;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76.6234%;\"\u003e\n \u003cp\u003eIntravenous\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThe study is retrospective and is compliant with the National Committee Bioethics (NCBE), Saudi Health Information Exchange (SeHe) policies, and Saudi Data and Artificial Intelligence Authority (SDAIA); as is detailed in Article 14.1 of the NCBE\u0026apos;s Implementing Regulations of the Law of Ethics of Research on Living Creatures. The report does not contain patient-specific data. All data have been de-identified to ensure total anonymity. The study has been approved by the Institutional Review Board at King Abdullah International Medical Research Center (KAIMRC) (Approval no. #0000096924) (Study number: NRR24/089/12).\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board at King Abdullah International Medical Research Center (KAIMRC; Approval No. #0000096924). The report does not contain patient-specific data; all information has been de-identified to ensure complete anonymity. Moreover, informed, explicit verbal and written consent was obtained to report the case. No incentives or compensation were offered to conduct the present report.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThe authors do not have any conflict of funding to declare.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contribution:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eM.A. conceptualized the study, wrote the case description, and reviewed the final manuscript. N.S.A. reviewed and wrote the background and introduction. N.A. contributed to the discussion and clinical implications. M.M.A. also contributed to the case description, abstract writing, and manuscript editing and took the initiative in the submission process. M.A.A. wrote the abstract and contributed to the discussion. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgement:\u003c/p\u003e\n\u003cp\u003eThis work was supported by King Abdulaziz Medical City, Ministry of National Guard and Health Affairs, Riyadh, Saudi Arabia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbolghasemi S, Sali S, Aghdam AM, Shahrbaf MA. Anti-tuberculosis induced Stevens-Johnson syndrome due to misdiagnosis of Mycobacterium abscessus urinary tract infection as tuberculosis. \u003cem\u003eIranian Journal of Kidney Diseases\u003c/em\u003e 2021; \u003cstrong\u003e15\u003c/strong\u003e(3): 235.\u003c/li\u003e\n\u003cli\u003eAl-Mashdali AF, Ali GA, Taha NM, Goravey W, Omrani AS. Mycobacterium abscessus urinary tract infection in an immunocompetent host: A case report and literature review. \u003cem\u003eIDCases\u003c/em\u003e 2022; \u003cstrong\u003e29\u003c/strong\u003e: e01538.\u003c/li\u003e\n\u003cli\u003eHuang CT, Chen CY, Chen HY, et al. Genitourinary infections caused by nontuberculous mycobacteria at a university hospital in Taiwan, 1996\u0026ndash;2008. \u003cem\u003eClinical Microbiology and Infection\u003c/em\u003e 2010; \u003cstrong\u003e16\u003c/strong\u003e(10): 1585-90.\u003c/li\u003e\n\u003cli\u003eLaudelino JS, Farias Filho FT, Costa AFP, Santos VM. Mycobacterium abscessus urinary tract infection: case report. \u003cem\u003eBrazilian Journal of Nephrology\u003c/em\u003e 2020; \u003cstrong\u003e42\u003c/strong\u003e(1): 124-6.\u003c/li\u003e\n\u003cli\u003eMehanni S, Joseph K, Casanas B, Greene J. Mycobacterium Abscessus Granulomatous Cystitis in a Patient With Superficial Bladder Cancer. \u003cem\u003eInfectious Diseases in Clinical Practice\u003c/em\u003e 2014; \u003cstrong\u003e22\u003c/strong\u003e(2): 116-7.\u003c/li\u003e\n\u003cli\u003eQvist T, Eickhardt S, Kragh KN, et al. Chronic pulmonary disease with \u003cem\u003eMycobacterium abscessus\u003c/em\u003e\u0026nbsp;complex is a biofilm infection. \u003cem\u003eEuropean Respiratory Journal\u003c/em\u003e 2015; \u003cstrong\u003e46\u003c/strong\u003e(6): 1823-6.\u003c/li\u003e\n\u003cli\u003eJohansen MD, Herrmann J-L, Kremer L. Non-tuberculous mycobacteria and the rise of Mycobacterium abscessus. \u003cem\u003eNature Reviews Microbiology\u003c/em\u003e 2020; \u003cstrong\u003e18\u003c/strong\u003e(7): 392-407.\u003c/li\u003e\n\u003cli\u003eWeng Y-W, Huang C-K, Sy C-L, Wu K-S, Tsai H-C, Lee SS-J. Treatment for Mycobacterium abscessus complex\u0026ndash;lung disease. \u003cem\u003eJournal of the Formosan Medical Association\u003c/em\u003e 2020; \u003cstrong\u003e119\u003c/strong\u003e: S58-S66.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mycobacterium abscessus, Urinary tract infection, Catheter-associated infection, Multidrug resistance, Non-tuberculous mycobacteria ","lastPublishedDoi":"10.21203/rs.3.rs-5731049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5731049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Urinary tract infections (UTIs) are a common health issue, especially among the elderly. While most UTIs are caused by typical bacterial pathogens, infections with atypical organisms like Mycobacterium abscessus, a non-tuberculous mycobacterium (NTM), are exceedingly rare. This case report details one such case of a 78-year-old woman with a complex medical history who developed a persistent UTI due to M. abscessus associated with urinary catheter use. Despite multiple courses of antibiotics, her symptomatology persisted, leading to the isolation of M. abscessus via acid-fast bacilli (AFB) culture. This case makes evident the challenges associated with diagnosing and managing NTM UTIs, especially given the organism’s resistance to standard treatments and the patient’s multiple comorbidities. A comprehensive review of relevant literature is provided, further delineating the rarity of genitourinary M. abscessus infections and the need for specialized diagnostic and therapeutic approaches.","manuscriptTitle":"Mycobacterium abscessus Urinary Tract Infection Associated with Urinary Catheter Use: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-23 14:58:35","doi":"10.21203/rs.3.rs-5731049/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"529b4854-2f39-4dc5-a94c-737f1d1f800e","owner":[],"postedDate":"January 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-06T14:40:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-23 14:58:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5731049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5731049","identity":"rs-5731049","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}