Clinical Characteristics and Treatment Outcomes of Patients with Acquired Macrolide-Resistant Mycobacterium abscessus Lung Disease

Abstract

Macrolide antibiotics are mainstays in the treatment of lung disease due to the complex. Although previous studies have reported development of acquired macrolide resistance in this species, limited data are available on the outcomes of lung disease due to macrolide-resistant subsp. This study evaluated the clinical features, treatment outcomes, and molecular characteristics of macrolide-resistant isolates of subsp. We performed a retrospective review of medical records and genetic analysis of clinical isolates from 13 patients who had acquired macrolide-resistant subsp. lung disease between November 2006 and March 2016. Eleven (85%) patients had the nodular bronchiectatic form of the disease, and two (15%) patients had the fibrocavitary form. When acquired macrolide resistance was detected, 10 (77%) patients were on antibiotic therapy for subsp. , and three (23%) patients were on therapy for lung disease due to other nontuberculous mycobacteria. The median treatment duration after detecting resistance was 24.0 months (interquartile range, 16.0 to 43.0 months). Treatment outcomes were poor, and final sputum culture conversion was achieved in only one (8%) patient, after resectional surgery. All 13 clinical isolates demonstrated point mutations at position 2058 ( = 10) or 2059 ( = 3) of the 23S rRNA gene, which resulted in acquired macrolide resistance. This study indicates that treatment outcomes are very poor after the development of acquired macrolide resistance in patients with subsp. lung disease. Thus, more effective measures are needed to prevent development and effectively treat macrolide-resistant subsp. lung disease.

Exposure of Mycobacterium abscessus to Environmental Stress and Clinically Used Antibiotics Reveals Common Proteome Response among Pathogenic Mycobacteria

“…abscessus (MAB) are extremely challenging to treat. The therapy involves combinational regimens with a minimum of three antibiotics and 18-24 months of duration to achieve some certain positive outcomes [3,32,33]. The fact is that the official regimens used for MAB treatment in clinics have a little or no evidence of in vivo efficacy [4] and, despite of combinational regimens, the success rate ranges from only 25% to 42% [12].…”

Amikacin Inhalation as Salvage Therapy for Refractory Nontuberculous Mycobacterial Lung Disease

“…Macrolides are the cornerstone drugs in the treatment of NTM-LD (4)(5)(6). Therefore, patients with macrolide-resistant MAC-LD (22)(23)(24)(25) or macrolide-resistant MABC-LD, including patients with lung disease caused by both isolates with intrinsic resistance and isolates with acquired resistance (26)(27)(28)(29)(30), have a very poor prognosis. In our study, salvage therapy with AMK inhalation was added to the existing (failing) regimens in all patients.…”

GenoType NTM-DR Performance Evaluation for Identification of Mycobacterium avium Complex and Mycobacterium abscessus and Determination of Clarithromycin and Amikacin Resistance

“…The study involved 145 clinical NTM isolates and a total of 38 reference strains, including 33 mycobacterial strains and 5 strains from the Gordonia, Nocardia, Rhodococcus, and Tsukamurella genera. The clinical NTM isolates consisted of 58 MAC and 87 M. abscessus isolates that were used in our previous studies and subcultured from frozen pure cultures stored at Ϫ70°C (13)(14)(15)(16). All clinical isolates were obtained from patients who fulfilled the diagnostic criteria of NTM pulmonary disease (1).…”