Mycobacterium abscessus

Benwill, Jeana L.; Wallace, Richard J.

doi:10.1097/qco.0000000000000104

Cited by 100 publications

(47 citation statements)

References 24 publications

(14 reference statements)

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“…In our study, the most frequent source of M. abscessus complex infections was respiratory (57.4%), similar to previous studies [1–3, 16, 17]. M. abscessus complex is known to cause infections in immunocompromised hosts [22–26].…”

Section: Discussionsupporting

confidence: 90%

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Sfeir

Walsh

Rosa

et al. 2018

Open Forum Infectious Diseases

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BackgroundInfections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States.MethodsA retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement.ResultsOne hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53–81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4–31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7–23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6–21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9–21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2–3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57–18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002–1.8; P = .04).ConclusionsOur cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

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Section: Discussionsupporting

confidence: 90%

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Sfeir

Walsh

Rosa

et al. 2018

Open Forum Infectious Diseases

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“…Mycobacterium abscessus is the most common, rapidly growing mycobacterial species that causes NTM pulmonary disease (11,(50)(51)(52)(53)(54)(55). Different subspecies may indicate divergent treatment plans, especially for those plans that involve clarithromycin (5,28,(46)(47)(48)(49)56).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Matrix-Assisted Laser Desorption Ionization−Time of Flight Mass Spectrometry for Identification of Mycobacterium abscessus Subspecies According to Whole-Genome Sequencing

Luo

Liu

et al. 2016

J Clin Microbiol

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cThis study was undertaken to evaluate the utility of matrix-assisted laser desorption ionization-time of flight mass spectrometry with the Vitek MS Plus system for identifying Mycobacterium abscessus subspecies in order to facilitate more rapid and appropriate therapy. A total of 175 clinical M. abscessus strains were identified by whole-genome sequencing analysis: 139 Mycobacterium abscessus subsp. abscessus and 36 Mycobacterium abscessus subsp. massiliense. The research-use-only (RUO) Saramis Knowledge Base database v.4.12 was modified accordingly by adding 40 M. abscessus subsp. abscessus and 19 M. abscessus subsp. massiliense reference spectra to construct subspecies SuperSpectra. A blind test, used to validate the remaining 116 isolates, yielded 99.1% (n ‫؍‬ 115) reliability and only 0.9% (n ‫؍‬ 1) error for subspecies identification. Among the two subspecies SuperSpectra, two specific peaks were found for M. abscessus subsp. abscessus and four specific peaks were found for M. abscessus subsp. massiliense. Our study is the first to report differential peaks 3,354.4 m/z and 6,711.1 m/z, which were specific for M. abscessus subsp. massiliense. Our research demonstrates the capacity of the Vitek MS RUO Saramis Knowledge Base database to identify M. abscessus at the subspecies level. Moreover, it validates the potential ease and accuracy with which it can be incorporated into the IVD system for the identification of M. abscessus subspecies. Mycobacterium abscessus is one of the most common pathogens isolated from patients with cystic fibrosis and the second most prevalent, rapidly growing nontuberculous mycobacteria (NTM) species causing NTM pulmonary diseases (1, 2). Although it might not be the most virulent NTM pathogen, inherent antibiotic resistance makes it notoriously difficult to treat (3-7). Among multiple resistance mechanisms, resistance to macrolides is noteworthy (8). In this regard, acquired resistance to clarithromycin is always associated with a mutation in the 23S rRNA gene; intrinsic resistance is conferred mainly by the erythromycin methylase (erm) gene (3). The erm gene plays a significant role in the drug susceptibility and antibiotic resistance of M. abscessus. Mycobacterium abscessus is divided into three subspecies: Mycobacterium abscessus subsp. massiliense, Mycobacterium abscessus subsp. bolletii, and Mycobacterium. abscessus subsp. abscessus (9). The most meaningful genomic difference between the three subspecies is that M. abscessus subsp. massiliense possesses an incomplete and inactive erm gene, which is 276 bp in length and harbors deletion mutations at two positions (10-13). M. abscessus subsp. massiliense can acquire clarithromycin resistance as a consequence of a 23S rRNA mutation at position A2058 (12,14). Due to an inactive erm gene, M. abscessus subsp. massiliense does not exhibit inducible resistance after exposure to macrolides. M. abscessus subsp. abscessus and M. abscessus subsp. bolletii, on the other hand, exhibit inducible resistance (9, 15). As a result, lung diseas...

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“…massiliense was describe to have a better prognosis and improved treatment outcomes than M. abscessus subsp. abscessus [9].…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium abscessus Urinary Infection in Hypertensive Patient: A Case Report

Fongoro¹,

Diallo²

2016

Mycobact Dis

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Mycobacterium abscessus is a common non tuberculous mycobacterium associated with diseases in patients with underlying conditions. The diagnosis is often missed in resource limited settings. We reported a case of M. abscessus in a patient with renal failure. A young female patient admitted at the hospital for kidney failure was diagnosed with malignant hypertension based on clinical and laboratory findings. Over the course of hospitalization, the patient presented hematuria and leukocyturia and the urine culture was positive for acid-fast bacilli. Empirically antituberculous treatment given to the patient was changed to clarithromycin after confirmation of M. abscessus by probe line hybridization assay. Favorable outcome was achieved with regression of symptoms and the decrease of the serum creatinine level. In patients with underlying conditions, differential diagnosis should be considered particularly in resource limited settings.

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Mycobacterium abscessus

Abstract: New studies differentiating M. abscessus subsp. abscessus and M. abscessus subsp. massiliense based on the erm(41) gene demonstrate the latter to have a better prognosis and improved treatment outcomes. M. abscessus subsp. abscessus remains a formidable pathogen in diagnosis and treatment.

Cited by 100 publications

References 24 publications

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Evaluation of Matrix-Assisted Laser Desorption Ionization−Time of Flight Mass Spectrometry for Identification of Mycobacterium abscessus Subspecies According to Whole-Genome Sequencing

Mycobacterium abscessus Urinary Infection in Hypertensive Patient: A Case Report

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