Mycobacterium abscessus. Madrid. This challenge starts from a poorly understood pathogenesis, continues with complicated subspecies variation in treatment response, and extends to the multidrug-resistant nature of these organisms. Wallace RJ Jr, Swenson JM, Silcox VA, Good RC, Tschen JA, Stone MS. Third, bacterial genotyping was not performed in nine patients who became culture positive again after initial sputum conversion. *Favorable microbiologic response was defined as sputum conversion and the maintenance of negative sputum cultures for more than 12 months. Daily half-dose linezolid for the treatment of intractable multidrug-resistant tuberculosis. Interestingly, some experts suggest that “holding” regimens of a macrolide plus a fluoroquinolone may be helpful for periods between the pulsed intravenous antibiotic therapies, even if in vitro susceptibility results reveal resistance to the fluoroquinolones (24). To better identify treatment ap-proaches and associated toxicities, we collected a series of case reports from the Emerging Infections Network. Additional detail on the method is provided in the online supplement. Four (6%) patients were either unable to produce sputum or had negative sputum cultures and subsequently underwent bronchoscopy. These germs are commonly found throughout the environment. However, frequent adverse reactions and the potential for long-duration hospitalization are important problems that remain to be solved. Pulmonary resections included lobectomy in six patients, pneumonectomy in three patients, bilobectomy in two patients, segmentectomy in one patient, and lobectomy plus segmentectomy in two patients. Proportions of Mycobacterium massiliense and Mycobacterium bolletii strains among Korean. By continuing to browse Mycobacterium abscessus is often resistant to multiple antimicrobial drugs, and data supporting effective drugs or dosing regimens are limited. Three (5%) patients, who presented with the upper lobe cavitary form of M. abscessus lung disease had complications of chronic necrotizing pulmonary aspergillosis. The roles of combined activities of fluoroquinolones with clarithromycin against M. abscessus are controversial. Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. In three patients who underwent surgical resection of localized disease and achieved sputum negative conversion, treatment finished at 13, 19, and 20 months, respectively. Es un grupo de micobacterias no tuberculosas … Importantly, they were able to show that the use of imipenem was associated with treatment success in MAB-PD overall (adjusted odds ratio 2.65, 95% CI 1.36–5.10), and for M. abscessus subsp. Treatment guidelines for NTM depend upon the type and extent of the infection, … Thus, we are not sure whether the recurrence was due to relapse with the original strain or reinfection with a genetically different strain (40, 41). Rationale: The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established. Additionally, if we are to better understand which treatment regimens offer the greatest chance of success, there is a need for consistency in approach to defining the end-points by which we measure treatment success. 2 Age and body mass index did not differ significantly between female and male patients. We retrospectively reviewed our prospectively collected institutional adult lung transplant database from 2001 to 2015 to identify patients with M. abscessus or Mycobacterium chelonae/abscessus infection before or after transplantation. We retrospectively reviewed the medical records of all patients with M. abscessus lung disease at the Samsung Medical Center (a 1,250-bed referral hospital in Seoul, South Korea) between January 2000 and December 2007. 2003. Of the 38 patients who achieved culture-negative sputum for more than 12 months, 32 patients completed their antibiotic therapy and were followed up for only a median of 12 months. Mycobacterium abscessus accounts for approximately 65 to 80% of lung disease caused by RGM (5–8). Diagnosis and treatment of infections caused by rapidly growing mycobacteria. intracellulare, and M. chimaera. Sputum smears and mycobacterial cultures were performed with standard methods (13). E-mail: American Journal of Respiratory and Critical Care Medicine. Recent studies showed that low MIC of clarithromycin was observed for M. massiliense compared with M. abscessus (37, 38). They demonstrated that overall treatment success for MAB-PD was 45.6% (95% CI 26.7–64.4). Complete blood cell counts, serum creatinine, and liver function test results were monitored twice a week during hospitalization. The lack of a representative and standardized model of chronic infection in mice has limited steps forward in the field of MA pulmonary infection. massiliense, where treatment success was higher, in 56.7% of cases, there was not this apparent association of treatment success with antibiotic choice, possibly because the better outcomes masked observable treatment effect. Initial and follow-up HRCT scans were available for all patients, and these images were reviewed by two of the authors (K. Jeon and W-J. A multiple logistic regression model revealed that resistance to clarithromycin was independently associated with failure to conversion or relapse (odds ratio, 0.03; 95% CI, 0.01–0.32; P = 0.004) (Table 6). Our study found that a combination antibiotic therapy is modestly effective in producing a favorable microbiologic response. Methods: Sixty-five patients (11 males, 55 females, median age 55 yr) with M. abscessus lung disease were treated with clarithromycin, ciprofloxacin, and doxycycline, together with an initial regimen of amikacin and cefoxitin for the first 4 weeks of hospitalization. Drug-induced hepatotoxicity (aspartate aminotransferase or alanine aminotransferase levels ≥ 120 IU/L) occurred in 10 (15%) patients. Of these 38 patients, 32 patients completed antibiotic treatment and were followed for a median of 11.9 months (IQR, 5.3–20.7 mo) without relapse. massiliense and M. abscessus subsp. The incidence of β-lactam antibiotic-induced neutropenia increases when parenteral treatment is used in higher doses and extends beyond 2 weeks (19, 20). Drug susceptibility tests were performed on M. abscessus isolates recovered from 45 patients as described above. Thus, the nomenclature of M. abscessus in the present study was referred to the M. abscessus group, which is now divided into three species: M. abscessus, M. massiliense and M. bolletii. Wallace RJ Jr, Meier A, Brown BA, Zhang Y, Sander P, Onyi GO, Bottger EC. Han XY, De I, Jacobson KL. After discharge, patients took a three-drug oral regimen for a total treatment duration of 24 months. Repeat positive cultures in. Currently, we are using two-drug regimens including clarithromycin and moxifloxacin after the initial parenteral therapy. Combination therapy of intravenous amikacin with cefoxitin or imipenem and an oral macrolide have been recommended by the American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) and many other experts (1–4). The remaining 15 patients continued antibiotic therapy until the end of December 2008 (median duration of treatment, 21.0 mo; IQR, 17.9–35.2 mo). In these 14 patients, 5 patients continued clarithromycin and ciprofloxacin after discontinuation of doxycycline. Our treatment regimen included an initial 4-week regimen of intravenous cefoxitin and amikacin administration. With this in mind, in this issue of the European Respiratory Journal, Kwak et al. Their intrinsic and easily acquired resistance to commonly used antibiotics (macrolides) make them naturally difficult to treat, as such antibiotics form the cornerstone of most treatment regimens used worldwide. To evaluate our institutional experience with Mycobacterium abscessus infections occurring in lung transplant recipients (LTR).. Methods. 1 Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa. A positive culture for Aspergillus fumigatus from sputum samples and clinical and radiographic evidence of a chronic infective process were recognized in all three patients. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF. Clinical, Radiographic, and Microbiologic Responses. Moreover, a study showed that moxifloxacin has a good activity against M. abscessus and combinations of clarithromycin and moxifloxacin were effective against M. abscessus strains in in vitro models (25). Standardized combination antibiotic regimen, which is largely based on clarithromycin use, together with an initial 4-week administration of cefoxitin and amikacin, is moderately effective in treating M. abscessus lung disease. M. abscessus can also be acquired from contaminated medical equipment, although most of these nosocomial infections in-volve the skin and soft tissues . M. abscessus . Koh WJ, Yu CM, Suh GY, Chung MP, Kim H, Kwon OJ, Lee NY, Chung MJ, Lee KS. Clinicians have the choice between personalized treatment regimens and standardized treatment regimens. All patients who were chosen to begin antibiotic therapy were hospitalized for 4 weeks and received a clarithromycin-containing three-drug oral regimen that included clarithromycin (1,000 mg/d), ciprofloxacin (1,000 mg/d), and doxycycline (200 mg/d), along with an initial 4-week course of amikacin (15 mg/kg/d in two divided doses) and cefoxitin (200 mg/kg/d, maximum 12 g/d in three divided doses) (17). For definition of abbreviations, see Table 1. Factors to consider must include the patient's age, severity of symptoms, and presence of comorbidities (32). Wayne, PA: NCCLS. 1A ). Therefore, further follow-up data are essential. In 28 of these 39 patients, imipenem was administered as a substitute for cefoxitin during the remaining 4 weeks of hospitalization. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; Approved Standard. In the study, researchers reported the case of an 8-year-old girl who was treated for an Mycobacterium abscessus infection and improved her bronchiectasis. Our treatment strategy for patients with M. abscessus lung disease is divided into two paths: reservation of antibiotic therapy for patients with mild forms of the disease and initiation of aggressive antibiotic therapy with standardized regimens for patients with severe or progressive forms of the disease. 1. Therefore, a total of 65 patients who received antibiotic therapy for more than 12 months were included in the study. For instance, M. abscessus has been labeled as Mycobacterium cheloneii subspecies abscessus, Mycobacterium chelonae subspecies abscessus, and finally, in 1992, as M. abscessus (34). In addition, sputum relapse after initial negative conversion was higher in patients infected with clarithromycin-resistant isolates (60%, 3/5) compared with those infected with clarithromycin-susceptible or intermediate isolates (16%, 4/25). Nontuberculous mycobacterial (NTM) lung infections are caused by NTM, most commonly M. avium complex (MAC). The effect of parenteral tigecycline, a drug increasingly used in the treatment of MAB-PD in the intravenous induction phase, could not be assessed as it was not used frequently in the patient level data analysed. M. abscessus complex is a rapidly growing nontuberculous mycobacterium, found ubiquitously in soil and water, which can be divided into a number of subspecies (subsp. Patients who received antibiotic therapy tended to be younger and mostly female and were more likely to have respiratory symptoms, positive sputum specimens based on acid-fast bacilli smears, and cavitation on chest radiography, compared with those who did not receive antibiotic therapy (Table 1). Yet expert guidelines, such as those from the American Thoracic Society/Infectious Diseases Society of America , and the British Thoracic Society , vary in recommended antibiotic strategies, ultimately muddying the waters when it comes to choosing the most efficacious therapies. TABLE 4. This follow-up duration after treatment completion was insufficient to detect sputum relapse in many patients. Chronic lung disease as a result of Mycobacterium abscessus is an emerging infection in the United States. Colle… ESR levels decreased to a median of 26.0 mm/h (IQR, 16.3–46.5 mm/h) after an initial 4 weeks of treatments and further decreased to a median of 17.5 mm/h (IQR, 12.0–42.0 mm/h) after 12 months of treatment (P < 0.001). Mycobacterium abscessus. Follow-up HRCT scans were performed at a median 12.2 months (IQR, 11.9–12.5 mo) after the start of antibiotic therapy. If an adverse reaction associated with cefoxitin occurred, imipenem (750 mg, three times a day) (3) was substituted for cefoxitin. Definition of abbreviations: AFB = acid-fast bacilli; IQR = interquartile range. Mycobacterium abscessus is a non-tuberculous mycobacterium increasingly recognized as an opportunistic pathogen in CF patients. abscessus, M. abscessus subsp. Se le cataloga como una subespecie de Mycobacterium chelonae hasta 1992.M. It is part of a group of environmental mycobacteria and is found in water, soil, and dust. Other mycobacterial species, including M. gordonae and M. kansasii, were identified at much lower frequencies (< … Treatment regimens cannot be optimized solely on the basis of retrospective studies with limited follow-up data; prospective clinical trials would be the proper approach. M. abscessus are thus environmentally acquired infections. Therefore, these side effects may limit the feasibility of the suggested prolonged treatment duration (i.e., 2–4 mo) of parenteral antibiotic therapy, including cefoxitin (1, 2). Thus, further studies are required to evaluate active combinations of oral antibiotics and determine their clinical importance. Al paciente se le indicó . The present study has several limitations. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. After the discontinuation of cefoxitin, the above adverse reactions resolved completely. To our knowledge, there has been no published study for more than 15 years that has focused on the antibiotic treatment of M. abscessus lung disease in a large sample of patients. NTM species were identified using a polymerase chain reaction and restriction length polymorphism method based on the rpoB gene, as previously described (9). Fourth, drug susceptibility results were available in only 69% (45/65) of patients. Nam HS, Koh WJ, Kwon OJ, Cho SN, Shim TS. Conflict of interest: M. Wilkie has nothing to disclose. The combination of clarithromycin and linezolid exhibits good in vitro activity against M. abscessus isolates (25, 29). A total of 65 patients (10 males and 55 females; median age, 55 yr [IQR 43–63 yr]) with M. abscessus lung disease who received combination antibiotic therapy for more than 12 months were included in the study. The broth microdilution MIC determination was not established in Korea during the early study period. A nonparametric repeated-measures analysis of variance (Friedman test) was performed to test for changes in erythrocyte sedimentation rates (ESR) with time. Pulmonary disease caused by Mycobacterium abscessus (MAB-PD) is of particular interest as, when coupled with underlying lung disease, it is associated with rapidly declining lung function, significant morbidity and mortality, and particularly poor treatment outcomes: cure, as generally defined by persistent culture conversion, is generally reported to be found in less than 50% of cases in … https://doi.org/10.1164/rccm.200905-0704OC, Refused further therapy before treatment completion, Death due to disease progression during the treatment, Initial sputum conversion and maintenance of conversion, Initial sputum conversion, with sputum relapse. Park S, Kim S, Park EM, Kim H, Kwon OJ, Chang CL, Lew WJ, Park YK, Koh WJ. Mycobacterium abscessus in both adults and children has been associated with a wide variety of clinical manifestations including the following: pulmonary infections; chronic otitis media; lymphadenitis; central line-associated blood stream infections, especially in oncology and hematopoietic stem cell transplant patients; and skin and soft tissue infections in both immune compromised and normal host children [20, 21, 47–49]. Surgical resection was performed in 14 (22%) patients. Our study results suggest that, for clarithromycin, there is a strong correlation between in vitro and in vivo results. The authors should be commended for focusing on this challenging infection, and for their work to obtain individual patient data from a wide geographic area (the studies offer a good representation of global NTM practice, with data from seven institutions from six countries spanning the globe). But perhaps more importantly, it shows that if nihilism is no longer the right answer, then we must also be better at framing new questions in the search for a roadmap to better therapies for our patients with MAB-PD (and indeed NTM-PD more broadly). The patients were treated over an 8-year period at a tertiary referral hospital in South Korea. In patients with substantial symptoms and/or advanced or progressive radiographic abnormalities, antibiotic therapy was initiated immediately. For the treatment of M. abscessus lung disease, clarithromycin administration plus at least one other agent to which the organism is susceptible may follow initial therapy. M. abscessus is resistant to many antibiotics and thus is very difficult to treat.  present a timely, and welcome, individual patient data meta-analysis of outcomes in MAB-PD. The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established. At the start of treatment, the median ESR was 45.0 mm/h (IQR, 27.5–73.0 mm/h). Although M. abscessus complex most commonly causes chronic lung infection and skin and soft tissue infection (SSTI), the complex can also cause infection in almost all human organs, mostly in patients with … Two patients were diagnosed at 14 and 26 months, respectively, after the initiation of antibiotic therapy, and one patient was diagnosed at 9 months after the completion of antibiotic treatment for M. abscessus lung disease. However, frequent adverse reactions and a long duration of hospitalization are problems that remain to be solved. We continue to use cefoxitin in the initial 4-week treatment period because of high in vitro susceptibility of M. abscessus isolates to cefoxitin and low reproducibility of susceptibility results for imipenem (1, 2). Online ISSN: 1399-3003, Copyright © 2021 by the European Respiratory Society, Dept of Respiratory Medicine, Ninewells Hospital and Medical School, Dundee, UK. Copyright © 1987-2020 American Thoracic Society, All Rights Reserved. CHARACTERISTICS OF 65 PATIENTS WITH MYCOBACTERIUM ABSCESSUS LUNG DISEASE WHO RECEIVED COMBINATION ANTIBIOTIC THERAPY FOR MORE THAN 12 MONTHS. Minimum inhibitory concentrations (MICs) of oral antimicrobials (clarithromycin, ciprofloxacin, and doxycycline) and parenteral antimicrobials (amikacin, cefoxitin, and imipenem) were determined using the broth microdilution method and interpreted according to the National Committee for Clinical Laboratory Standards guidelines (14). Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene. Mycobacterium tuberculosis was not isolated. Therefore, 38 (58%) of the 65 patients' sputum converted and remained culture negative until the end of December 2008. Out of 24 (37%) patients who did not complete the full course of treatment, 3 patients refused further therapy due to adverse reactions at 15, 15, and 39 months, respectively. These rates were significantly lower in patients whose isolates were resistant to clarithromycin (17%, 2/12) compared with those whose isolates were susceptible or intermediate to clarithromycin (64%, 21/33; P = 0.007). Therefore, the microbiologic response rate, which was defined as sputum conversion and the maintenance of negative sputum cultures for more than 12 months, was significantly lower in patients infected with clarithromycin-resistant isolates (17%, 2/12) compared with patients infected with clarithromycin-susceptible or intermediate isolates (64%, 21/33; P = 0.007) (Table 6). †High off-scale MICs were converted to the next-highest concentration. M. abscessus is resistant to many antibiotics and thus is very difficult to treat. The optimal therapeutic regimen and duration of treatment for M. abscessus lung disease has not been established. Chan ED, Kaminska AM, Gill W, Chmura K, Feldman NE, Bai X, Floyd CM, Fulton KE, Huitt GA, Strand MJ. The administered drugs included amikacin (58%), cefoxitin (43%), erythromycin (31%), and antituberculosis agents (37%) (6). Mycobacterium abscessus complex is an ubiquitous, rapidly growing mycobacterium.1,2 The lungs are the most frequent site of infection, and M. abscessus infections progress slowly if left untreated.1,4 A history of chronic cough is often present initially, whereas fever and constitutional symptoms are seen with Defining treatment success as culture conversion for ≥12 months while on treatment, or sustained culture conversion without relapse, they were able to analyse individual data from 303 patients from eight of 14 eligible studies. However, the relationship between in vitro susceptibility results for M. abscessus and clinical responses to these agents has not been established. The authors thank Ms. Shinok Kim of the Korean Institute of Tuberculosis and Ms. Eun Mi Park of Samsung Medical Center for their assistance and technical support. Close observation is indicated if the decision is made not to treat. Four patients completely discontinued antibiotic therapy because of severe gastrointestinal symptoms after a median period of 15 months (IQR, 14.5–15.0 mo). Nontuberculous mycobacteria (NTM) are a heterogeneous group of organisms that occasionally are a primary cause of lung disease but more commonly affect patients with underlying chronic lung disease such as bronchiectasis, pneumoconiosis, or healed tuberculosis (1, 2). Nucleotide-binding oligomerization domain (NOD) 2 is a cytosolic receptor which senses a bacterial peptidoglycan component, muramyl dipeptide (MDP). Because the majority of the data did not follow a normal distribution, all results in the text or tables are expressed as the median and IQR, or as the number (percentage) of patients. The challenge is amplified by the fact that the incidence of MAB-PD may also be increasing , possibly as a result of ageing populations with pre-existing lung disease, alongside increasing use of immunosuppressant drugs, and increased environmental exposure. Sputum conversion rates were lower in patients whose isolates were resistant to clarithromycin (42%, 5/12) compared with those whose isolates were susceptible or intermediate to clarithromycin (76%, 25/33). Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Furthermore, both sputum conversion rates and relapse rates were significantly associated with clarithromycin resistance in this study. Because of these adverse reactions, cefoxitin was discontinued in 39 (60%) patients after treatment for a median of 22 days (IQR, 20–24 d). Despite significantly variable geographic distributions, Mycobacterium abscessus (M. abscessus) complex is one of the most important pathogens responsible for causing pulmonary nontuberculous mycobacteria (NTM) diseases worldwide .In some East Asian countries, M. abscessus complex is the second most common pathogen responsible for NTM lung diseases after the Mycobacterium … MINIMUM INHIBITORY CONCENTRATIONS BREAKPOINTS AND IN VITRO SUSCEPTIBILITY OF MYCOBACTERIUM ABSCESSUS (N = 45). Finally, as the authors illustrate, this is the first individual patient data meta-analysis in the NTM-PD field, but was ultimately only able to include 303 patients. The other 18 (28%) patients, including 2 patients who died of disease progression, failed to achieve sputum conversion. MYCOBACTERIUM TB: Acid -fast bacilli are slow growing aerobic, commonly found in the lungs. However, when challenged with a high‐dose aerosol (HDA), … National Committee for Clinical Laboratory Standards. Italic and bold type indicate susceptible and resistant categories of interpretive criteria to each antimicrobial agent, respectively. Mycobacterium abscessus (M. abscessus) is the most common strain of non-tuberculous mycobacteria (NTM). This is an open-label study of efficacy, safety and tolerability of once daily dosing of Liposomal-Amikacin for Inhalation (LAI), in addition to a standard multi-drug antibiotic therapy in accordance with the 2007 ATS/ IDSA guidelines, in patients with Mycobacterium abscessus lung disease.
mycobacterium abscessus in lungs 2021