Mycobacterium abscessus Complex Infections in Children: A Review

Abstract

Purpose of Review Infections in children with Mycobacterium abscessus complex represent a particular challenge for clinicians. Increasing incidence of these infections worldwide has necessitated focused attention to improve both diagnostic as well as treatment modalities. Published medical literature was reviewed, with emphasis on material published in the past 5 years. Recent Findings Increasing availability of new diagnostic tools, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry and custom PCRs, has provided unique insights into the subspecies within the complex and improved diagnostic certainty. Microbiological review of all recent isolates at the University of Minnesota Medical Center was also conducted, with description of the antimicrobial sensitivity patterns encountered in our center, and compared with those published from other centers in the recent literature. A discussion of conventional antimicrobial treatment regimens, alongside detailed description of the relevant antimicrobials, is derived from recent publications. Summary Antimicrobial therapy, combined with surgical intervention in some cases, remains the mainstay of pediatric care. Ongoing questions remain regarding the transmission mechanics, immunologic vulnerabilities exploited by these organisms in the host, and the optimal antimicrobial regimens necessary to enable a reliable cure. Updated treatment guidelines based on focused clinical studies in children and accounting especially for the immunocompromised children at greatest risk are very much needed.

Dual β-Lactam Combinations Highly Active against Mycobacterium abscessus Complex In Vitro

“…abscessus pulmonary infections with drug classes that include a macrolide (e.g., clarithromycin or azithromycin), an aminoglycoside (e.g., amikacin), and a β-lactam (e.g., cefoxitin or imipenem) (7, 22–24). However, the recognition that macrolide resistance, now present in over 50% of clinical isolates (30), dramatically alters treatment outcomes has fueled the search for better treatment options, since the clearance of MABC from sputum ranges from 45 to 75% in patients with macrolide-susceptible strains but ranges from only 5 to 15% in patients with resistant strains (5).…”

In Vitro Susceptibility of Mycobacterium abscessus and Mycobacterium fortuitum Isolates to 30 Antibiotics

“…M. abscessus is an opportunistic pathogen, which can cause human to human infection [7] and nosocomial infection [8]. It was reported to cause multiple community outbreaks of cutaneous infection by means of wading pool or swimming pool [9–11].…”

Mycobacterium abscessus infection in a spa worker

“…Cutaneous infections with M. abscessus usually occur by inoculation of the bacteria following trauma of the skin with contaminated devices such as inadequately sterilized medical equipment and after mesotherapy, tattooing, acupuncture, and insulin injections (1,2). Frequently, contamination with non-tuberculous mycobacterium occurs through tap water (5,7). However, in most outbreaks, as well as in our case, the infection source remains unknown.…”

“…Multiple treatment modalities are recommended, including surgery and a long course of antibiotics that can be used in combination (1). M. abscessus is inherently resistant to current first-line antituberculosis drugs, but recently rifabutin has shown potential efficacy (7,10). Due to both natural and acquired resistance to most currently available antibiotics, combination therapy, which includes macrolide, aminoglycoside, carbapenem, and new quinolones, is frequently used (4).…”