Clinical characteristics and antimicrobial management of invasive Mycoplasma hominis infection: a case report and literature review

Objective This research aims to report a case of invasive Mycoplasma hominis ( M. hominis ) infection of a distal fibular wound and to provide a review of the literature in order to elucidate the clinical features and antimicrobial management of this uncommon pathogen. Methods We describe a case of invasive M. hominis wound infection in a 60-year-old male following an open distal fibular fracture. In addition, we performed a narrative review of the literature via a PubMed search for reports of invasive M. hominis infection in adults published up to August 2025, restricted to adult cases. Extracted variables included demographic characteristics, underlying conditions, infection sites, antimicrobial regimens, and clinical outcomes. Results Invasive M. hominis infection was most common in patients with surgery/urinary catheterization history, cardiopulmonary insufficiency, immunosuppression, or post-transplantation status. Primary infection sites were skin/bone, pleural/peritoneal effusions, and the central nervous system. Among 65 cases, 17 (26.2%) experienced treatment failure. Failure rates were 22.5% (9/40) in doxycycline-containing regimens and 32.0% (8/25) in non-doxycycline regimens, with no significant difference ( p = 0.397). Prolonged antimicrobial therapy was protective against failure [OR 0.089 (0.017–0.466)], while post-transplantation status increased risk [OR 6.045 (1.053–34.710)]. Mortality was often multifactorial, especially in transplant recipients. Conclusion Invasive M. hominis infections, though likely underdiagnosed and underreported, can lead to severe outcomes, particularly in patients with a history of surgery, urinary catheterization, or immunosuppression. Prolonged antimicrobial therapy is associated with improved outcomes, whereas post-transplantation status increases the risk of failure. Doxycycline-containing regimens, especially combined with fluoroquinolones, are a preferred therapeutic strategy. Heightened clinical vigilance and optimized diagnostic and therapeutic approaches are critical to reduce treatment failure.