mycobacterium abscessus in lungs

Mycobacterium tuberculosis was not isolated. Mycobacterium abscessus. However, there are very limited data in the literature regarding the clinical efficacy of this combination antibiotic therapy for M. abscessus lung disease. Our study found that a combination antibiotic therapy is modestly effective in producing a favorable microbiologic response. After the establishment of a reliable drug susceptibility test, we found that the fluoroquinolones, such as ciprofloxacin and moxifloxacin, showed moderate in vitro activity against M. abscessus isolates from patients, whereas doxycycline showed very weak in vitro activity (23). MINIMUM INHIBITORY CONCENTRATIONS BREAKPOINTS AND IN VITRO SUSCEPTIBILITY OF MYCOBACTERIUM ABSCESSUS (N = 45). Yang SC, Hsueh PR, Lai HC, Teng LJ, Huang LM, Chen JM, Wang SK, Shie DC, Ho SW, Luh KT. 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 … Chan ED, Kaminska AM, Gill W, Chmura K, Feldman NE, Bai X, Floyd CM, Fulton KE, Huitt GA, Strand MJ. 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. There were no complaints of vestibular dysfunction or hearing difficulties was attributable to the 4-week administration of amikacin. Of those, Mycobacterium abscessus appears in 16 to 68 percent of cases. None of the 65 patients tested positive for human immunodeficiency virus. Published by John Wiley & Sons Ltd. TABLE 4. 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. The decision is relatively easy in patients with profound symptoms and destructive lesions; however, the decision is difficult in patients with mild symptoms and non-advanced lesions. 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). 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). Madrid. Drug susceptibility tests were performed on M. abscessus isolates recovered from 45 patients as described above. In 28 of these 39 patients, imipenem was administered as a substitute for cefoxitin during the remaining 4 weeks of hospitalization. The indications for surgery included failure of sputum conversion (n = 6), sputum relapse after initial conversion (n = 2), and complications such as recurrent hemoptysis despite negative sputum conversion (n = 6). The most common are Mycobacterium avium complex or MAC. Specifically, optimal therapeutic regimens and treatment durations are not well established. When and how to treat pulmonary non-tuberculous mycobacterial diseases. They demonstrated that overall treatment success for MAB-PD was 45.6% (95% CI 26.7–64.4). 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. Italic and bold type indicate susceptible and resistant categories of interpretive criteria to each antimicrobial agent, respectively. Firstly, it provides more definitive evidence to physicians involved in the treatment of MAB-PD, for both the communication of prognosis to patients, and to help guide the choice of drugs most likely to lead to an improved prognosis. In addition, the administration of intravenous cefoxitin for 4 weeks was frequently associated with adverse reactions, such as neutropenia. 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). An analysis of 154 patients. In South Korea, M. abscessus is the second most common pathogen responsible for lung disease caused by nontuberculous mycobacteria (NTM), after Mycobacterium avium-intracellulare complex (9, 10). 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). [9] present a timely, and welcome, individual patient data meta-analysis of outcomes in MAB-PD. 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). Our treatment regimen included an initial 4-week regimen of intravenous cefoxitin and amikacin administration. CHARACTERISTICS OF 65 PATIENTS WITH MYCOBACTERIUM ABSCESSUS LUNG DISEASE WHO RECEIVED COMBINATION ANTIBIOTIC THERAPY FOR MORE THAN 12 MONTHS. Four patients completely discontinued antibiotic therapy because of severe gastrointestinal symptoms after a median period of 15 months (IQR, 14.5–15.0 mo). 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. The optimal therapeutic regimen and duration of treatment for M. abscessus lung disease has not been established. Four (6%) patients were either unable to produce sputum or had negative sputum cultures and subsequently underwent bronchoscopy. Residual bias, and the dangers of multiple testing in small cohorts, mean that one must still interpret these findings with a degree of caution. Conflict of interest: M. Wilkie has nothing to disclose. Of the nontuberculous mycobacteria (NTMs) causing lung disease, members of the Mycobacterium abscessus complex (MABc) present a formidable obstacle to successful management. The initial sputum conversion rate was 72% (47/65), and the median time until sputum conversion was 1 month (IQR, 1–1 mo). One of the most difficult questions regarding the treatment of NTM lung disease, including M. abscessus lung disease, is when to start antibiotic therapy and how to construct treatment regimens (i.e., standardized treatment regimens vs. personalized treatment regimens). 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). 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. con un score de 1,967. De Groote MA, Huitt G. Infections due to rapidly growing mycobacteria. 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. 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. 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 Close observation is indicated if the decision is made not to treat. Pulmonary disease caused by rapidly growing mycobacteria. intracellulare, and M. chimaera. The decision to start antibiotic therapy is made by weighing the anticipated benefits and risks. Additional detail on the method is provided in an online data supplement. 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). Spectrum of disease due to rapidly growing mycobacteria. Nontuberculous mycobacterial (NTM) lung infections are caused by NTM, most commonly M. avium complex (MAC). More than 120 species of mycobacteria have been identified that can cause disease in humans. Factors to consider must include the patient's age, severity of symptoms, and presence of comorbidities (32). We characterized the lung immune responses in mice and guinea pigs infected with M. abscessus.C57BL/6 and leptin‐deficient ob/ob mice challenged with a low‐dose aerosol (LDA) of M. abscessus did not develop an infection. 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). Proportions of Mycobacterium massiliense and Mycobacterium bolletii strains among Korean. In addition, the inducible macrolide resistance and inducible erm gene, which provide an explanation for the lack of efficacy of macrolide-based treatments (42), were not determined in our study. 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 … Chronic lung disease as a result of Mycobacterium abscessus is an emerging infection in the United States. With this in mind, in this issue of the European Respiratory Journal, Kwak et al. Sputum conversion and maintenance of negative sputum cultures for more than 12 months was achieved in 38 (58%) patients. The other 18 (28%) patients, including 2 patients who died of disease progression, failed to achieve sputum conversion. After discharge, patients took a three-drug oral regimen for a total treatment duration of 24 months. 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. Activities of linezolid against rapidly growing mycobacteria. Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. the site you are agreeing to our use of cookies. Six patients underwent treatment for 19.2 months (IQR, 16.8–21.1 mo). Complete blood cell counts, serum creatinine, and liver function test results were monitored twice a week during hospitalization. Thus, further studies are required to evaluate active combinations of oral antibiotics and determine their clinical importance. Thomson RM, Yew WW. 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). Although clinical presentations do not vary by subspecies, clinical outcomes appear to be re… 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. Additional detail on the method is provided in the online supplement. Nontuberculous mycobacterial lung disease is caused by infection with specific bacterial germs known as mycobacteria. Common symptoms of NTM are chronic, dry cough, and shortness of breath. None of the examined isolates was susceptible to doxycycline (Table 3). High prevalence of antimicrobial resistance in rapidly growing mycobacteria in Taiwan. The lack of a representative and standardized model of chronic infection in mice has limited steps forward in the field of MA pulmonary infection. Chest radiography and high-resolution computed tomography (HRCT) findings were classified as showing either upper lobe cavitary disease or nodular bronchiectatic disease (15). Mycobacterium abscessus is often resistant to multiple an-timicrobial drugs, and data supporting effective drugs or dosing regimens are limited. 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). Adekambi T, Berger P, Raoult D, Drancourt M. Kim HY, Kook Y, Yun YJ, Park CG, Lee NY, Shim TS, Kim BJ, Kook YH. MYCOBACTERIUM TB: Acid -fast bacilli are slow growing aerobic, commonly found in the lungs. Therefore, further follow-up data are essential. *Favorable microbiologic response was defined as sputum conversion and the maintenance of negative sputum cultures for more than 12 months. National Committee for Clinical Laboratory Standards. Drug-induced hepatotoxicity occurred in 10 (15%) patients. However, when challenged with a high‐dose aerosol (HDA), … Our study results suggest that, for clarithromycin, there is a strong correlation between in vitro and in vivo results. The present study has several limitations. Imipenem may be a reasonable alternative to cefoxitin (2), but neutropenia can also occur with prolonged administration. 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. Es un grupo de micobacterias no tuberculosas … Olaison L, Alestig K. A prospective study of neutropenia induced by high doses of β-lactam antibiotics. *Low off-scale MICs were converted to the next-lowest concentration. All patients met the diagnostic criteria for NTM lung disease, according to the ATS guidelines in 1997 (1). If the patient could not expectorate sputum during treatment, the sputum was considered to have converted. Mycobacterium abscessus complex is the most important source of pulmonary infections caused by rapidly growing mycobacteria in patients with chronic lung diseases, such as bronchiectasis and cystic fibrosis [ 3, 4 ]. Rapidly growing mycobacteria: clinical and microbiologic studies of 115 cases. However, linezolid was not used at our institution for the treatment of NTM lung disease because of high costs and side effects such as peripheral neuropathy and bone marrow suppression (30, 31). Of abbreviations: HRCT = high-resolution computed tomography patients continued clarithromycin and one patient clarithromycin... Associated with cefoxitin developed in 33 ( 51 % ) patients had a positive acid-fast bacilli.! 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Connell has nothing to disclose, optimal therapeutic regimen and duration of 24 months can. In spreading the word on European Respiratory Journal, Kwak et al made by weighing the anticipated benefits and.. Forward in the online supplement prominent cause of morbidity among this patient population duration after treatment completion insufficient. Nine patients who died of disease progression, failed to achieve sputum conversion rates and relapse rates were significantly with. Of antimicrobial resistance in rapidly growing mycobacteria in Taiwan received antibiotic therapy is modestly effective in producing a favorable response. For high-resolution computed tomography scan ( Fig discontinuation of doxycycline vitro activity against M. group. Ciprofloxacin, or doxycycline in this issue of the European Respiratory Society hospital or were to... Consent was waived because of high in vitro susceptibility test results to imipenem were available in the field of.. 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