The Treatment of Rapidly Growing Mycobacterial Infections

Kasperbauer, Shannon; Groote, Mary Ann De

doi:10.1016/j.ccm.2014.10.004

Cited by 89 publications

(90 citation statements)

References 62 publications

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“…Due to the intrinsic resistance to most available antibiotics, the nontuberculous mycobacteria pose a unique challenge for clinical treatment (12). There is interest in evaluating new anti-TB compounds against NTM, which will provide new options for (14), which is significantly lower than the MIC 50 of 0.03 mg/liter from the current study.…”

Section: Discussionmentioning

confidence: 80%

“…Because they are opportunistic pathogens, overexposure to broad-spectrum antibiotics in the natural habitat may accelerate the emergence of intrinsically drugresistant MAC strains by decreasing cell permeability, which also may be a potential reason for the different bimodal MIC distribution profiles of MAC strains. M. abscessus infections are associated with the lowest cure rate among various NTM species, which is largely due to the emergence of inducible macrolide resistance in M. abscessus (12). As a consequence, the treatment of clarithromycin-resistant M. abscessus relies on the use of amikacin and cefoxitin (12,18), although a recent study from China reported that 32% and 55% of M. abscessus isolates were resistant and intermediate to cefoxitin, respectively (19).…”

Section: Discussionmentioning

confidence: 99%

“…M. abscessus infections are associated with the lowest cure rate among various NTM species, which is largely due to the emergence of inducible macrolide resistance in M. abscessus (12). As a consequence, the treatment of clarithromycin-resistant M. abscessus relies on the use of amikacin and cefoxitin (12,18), although a recent study from China reported that 32% and 55% of M. abscessus isolates were resistant and intermediate to cefoxitin, respectively (19). Considering the large proportion of cefoxitin-resistant isolates, the use of bedaquiline is more likely to be a promising choice for M. abscessus infections in China.…”

Section: Discussionmentioning

confidence: 99%

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In Vitro Activity of Bedaquiline against Nontuberculous Mycobacteria in China

Pang

Zheng

Tan

et al. 2017

Antimicrob Agents Chemother

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The main goal of our study was to evaluate the in vitro bedaquiline susceptibility of six prevalent species of pathogenic nontuberculous mycobacteria (NTM) in China. In addition, we investigated the potential molecular mechanisms contributing to bedaquiline resistance in the different NTM species. Among slowly growing mycobacteria (SGM), bedaquiline exhibited the highest activity against 44 (20.2%), 42 (25.8%), and 7 (31.8%), respectively, were resistant to bedaquiline. No significant differences in the proportions of bedaquiline resistance among these species were observed (P Ͼ 0.05). Genetic mutations were observed in 74 isolates (10.8%), with all nucleotide substitutions being synonymous. In conclusion, our data demonstrate that bedaquiline shows moderate in vitro activity against NTM species. Using the proposed ECOFF values, we could distinguish between bedaquiline-resistant and -susceptible strains with the broth dilution method. In addition, no nonsynonymous mutations in the atpE gene that conferred bedaquiline resistance in all six NTM species were identified.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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In Vitro Activity of Bedaquiline against Nontuberculous Mycobacteria in China

Pang

Zheng

Tan

et al. 2017

Antimicrob Agents Chemother

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“…In M. abscessus -PD, sustained culture conversion and clinical improvement can often not be achieved with any presently available drugs independently of the chosen regimen [136]. Symptom control and microbial suppression may be the best achievable goal of therapy.…”

Section: Managementmentioning

confidence: 99%

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

Wassilew¹,

Hoffmann²,

Andréjak³

et al. 2016

Respiration

125

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Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.

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“…However, the type and duration of antimicrobial treatment for NTM-related infections is poorly understood due to a lack of clinical trials [3,13,14]. Patients with M. fortuitum group SSTIs should be treated for at least 4 to 6 months with two active agents [3,15]. It has also been suggested that the treatment regimen for non-pulmonary disease caused by RGM (M. abscessus, M. chelonae, M. fortuitum) should be based on in vitro susceptibility testing before administering it to the patient.…”

Section: Discussionmentioning

confidence: 99%

Complicated skin and soft tissue infection with Mycobacterium fortuitum following excision of a sebaceous cyst in Taiwan

Tsai

Chen

Liao

et al. 2016

J Infect Dev Ctries

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Mycobacterium fortuitum group (M. fortuitum), also known as rapidly growing Mycobacteria, can cause pyogenic infections in human beings, most commonly in immunocompromised patients. Herein, we present a 40-year-old immunocompetent male patient who underwent planned excision of a sebaceous cyst in the abdominal wall. He suffered from tender erythematous lesions with purulent discharge around the healing wound that developed 2 weeks after surgery. Gram stain, bacterial and fungal culture results of the wound were negative. A diagnosis of nontuberculous mycobacteria was made from a wound culture from the area of operative debridement, which was subsequently confirmed to be M. fortuitum group using PCR-restriction fragment length polymorphism analysis of the hsp65 gene. The patient received 4 weeks of parenteral imipenem/cilastatin 500 mg every 6 hours and amikacin 500 mg every 12 hours, plus oral clarithromycin 500 mg twice daily, and the wound recovered completely. He was discharged and followed up regularly at our outpatient clinic, and continued taking oral ciprofloxacin and clarithromycin 500 mg twice daily for 6 months. This case highlights the importance of strict aseptic precautions even during minor procedures, and also the characteristics of M. fortuitum infections in immunocompetent patients, which usually develop as localized postsurgical wound infections. We also share our experience in successfully treating a M. fortuitum complicated skin and soft tissue infection.

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The Treatment of Rapidly Growing Mycobacterial Infections

Cited by 89 publications

References 62 publications

In Vitro Activity of Bedaquiline against Nontuberculous Mycobacteria in China

In Vitro Activity of Bedaquiline against Nontuberculous Mycobacteria in China

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

Complicated skin and soft tissue infection with Mycobacterium fortuitum following excision of a sebaceous cyst in Taiwan

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