M. abscessus . The challenge is amplified by the fact that the incidence of MAB-PD may also be increasing [6], possibly as a result of ageing populations with pre-existing lung disease, alongside increasing use of immunosuppressant drugs, and increased environmental exposure. Sputum relapse was defined as two consecutive positive cultures after sputum conversion (18). Out of 188 patients with M. abscessus lung disease, 102 (54%) patients did not receive antibiotic therapy for the following reasons: mild symptoms and no clear evidence of disease progression during the observation period (n = 83; median follow-up duration, 20.5 mo; interquartile range [IQR, 25th and 75th percentiles] 12.8–38.0 mo); lost to follow-up (n = 8; median follow-up duration, 17.7 mo; IQR 4.3–39.3 mo); transfer to another hospital after diagnosis of M. abscessus lung disease (n = 6; median follow-up duration, 11.2 mo; IQR 8.2–54.5 mo); or death due to another disease (n = 5; median follow-up duration, 24.5 mo; IQR 13.3–51.2 mo). Mycobacterium abscessus [mī–kō–bak–tair–ee–yum ab–ses–sus] (also called M. abscessus) is a bacterium distantly related to the ones that cause tuberculosis and Hansen’s Disease (Leprosy). Four (6%) patients were either unable to produce sputum or had negative sputum cultures and subsequently underwent bronchoscopy. As shown in Table 5, response rates were 83% based on symptoms and 74% based on HRCT findings. Es un grupo de micobacterias no tuberculosas … *Low off-scale MICs were converted to the next-lowest concentration. con un score de 1,967. 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. Spectrum of disease due to rapidly growing mycobacteria. abscessus (where treatment success was found in only 33% of cases), the use of azithromycin (but not clarithromycin), and parenteral amikacin was also related to treatment success; cefoxitin was not associated with treatment success. Although clinical presentations do not vary by subspecies, clinical outcomes appear to be re… Sputum conversion was defined as three consecutive negative cultures within 6 months, with the time of conversion defined as the date of the first negative culture. 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). Clinicians have the choice between personalized treatment regimens and standardized treatment regimens. A total of 65 patients (10 males and 55 females; median age, 55 yr [IQR 43–63 yr]) with M. abscessus lung disease who received combination antibiotic therapy for more than 12 months were included in the study. 1A ). In addition, M. bolletii was reported to be naturally resistant to clarithromycin (36, 39). Of the oral antibiotics, clarithromycin showed moderate in vitro activity against the isolates (73%, 33/45), but demonstrated better in vitro activity than ciprofloxacin (47%, 21/45). The other 18 (28%) patients, including 2 patients who died of disease progression, failed to achieve sputum conversion. Of the 38 patients who achieved culture-negative sputum for more than 12 months, 32 patients completed their antibiotic therapy and were followed up for only a median of 12 months. Pulmonary Mycobacterium abscessus: can we identify the road to improved outcomes. Negative sputum culture conversion was achieved within a median duration of 1.5 months (IQR, 1.0–2.0 mo) postoperatively and was maintained in seven (88%) of eight patients with preoperative culture-positive sputum. Informed consent was waived because of the retrospective nature of the study. However, frequent adverse reactions and the potential need for prolonged hospitalization are important issues that remain to be resolved. Second, the number of sputum specimens collected over time was relatively low. Treatment regimens cannot be optimized solely on the basis of retrospective studies with limited follow-up data; prospective clinical trials would be the proper approach. TABLE 6. 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). Their intrinsic and easily acquired resistance to commonly used antibiotics (macrolides) make them naturally difficult to treat, as such antibiotics form the cornerstone of most treatment regimens used worldwide. The American Thoracic Society reports a prevalence of 6 to 13 percent of CF patients having NTM. Therefore, a total of 65 patients who received antibiotic therapy for more than 12 months were included in the study. I have been diagnosed with Mycobacterium abcessus and Mycobacterium chelanae. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 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 Cremades R, Santos A, Rodriguez JC, Garcia-Pachon E, Ruiz M, Escribano I, Royo G. Screening for sterilizing activity of antibiotic combinations in an acid model of rapidly growing mycobacteria during the stationary phase of growth. Genetic basis for clarithromycin resistance among isolates of, Brown-Elliott BA, Wallace RJ Jr. Clarithromycin resistance to. After discussing this information with the patients, we implemented an observation period of at least 6 to 12 months without antibiotic treatment. 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. Madrid. Isolates are usually susceptible only in vitro to the parenteral agents amikacin, cefoxitin, and imipenem, and to oral macrolides (clarithromycin and azithromycin) (1, 2 ATS/IDSA recommendations suggest that susceptibility to some agents, such as amikacin, cefoxitin, clarithromycin, ciprofloxacin, and doxycycline, should be reported and used to guide treatment (1, 2). NTM species were identified using a polymerase chain reaction and restriction length polymorphism method based on the rpoB gene, as previously described (9). COMPARISON OF THE CLINICAL AND RADIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH MYCOBACTERIUM ABSCESSUS LUNG DISEASE WHO RECEIVED ANTIBIOTIC THERAPY WITH THOSE WHO DID NOT RECEIVE ANTIBIOTIC THERAPY. Most importantly, whether or not a favorable microbiologic response will continue cannot be readily determined. None of the 65 patients tested positive for human immunodeficiency virus. Three patients were able to continue antibiotic therapy after reduction of the clarithromycin dosage (500 mg/d). A nonparametric repeated-measures analysis of variance (Friedman test) was performed to test for changes in erythrocyte sedimentation rates (ESR) with time. Thomson RM, Yew WW. TABLE 4. Of the nontuberculous mycobacteria (NTMs) causing lung disease, members of the Mycobacterium abscessus complex (MABc) present a formidable obstacle to successful management. Complete blood cell counts, serum creatinine, and liver function test results were monitored twice a week during hospitalization. It is part of a group of environmental mycobacteria and is found in water, soil, and dust. E-mail: American Journal of Respiratory and Critical Care Medicine. massiliense, where treatment success was higher, in 56.7% of cases, there was not this apparent association of treatment success with antibiotic choice, possibly because the better outcomes masked observable treatment effect. Identificación rápida de . MINIMUM INHIBITORY CONCENTRATIONS BREAKPOINTS AND IN VITRO SUSCEPTIBILITY OF MYCOBACTERIUM ABSCESSUS (N = 45). In addition, the administration of intravenous cefoxitin for 4 weeks was frequently associated with adverse reactions, such as neutropenia. Drug-induced hepatotoxicity (aspartate aminotransferase or alanine aminotransferase levels ≥ 120 IU/L) occurred in 10 (15%) patients. https://doi.org/10.1164/rccm.200905-0704OC, Refused further therapy before treatment completion, Death due to disease progression during the treatment, Initial sputum conversion and maintenance of conversion, Initial sputum conversion, with sputum relapse. Therefore, these side effects may limit the feasibility of the suggested prolonged treatment duration (i.e., 2–4 mo) of parenteral antibiotic therapy, including cefoxitin (1, 2). The lack of a representative and standardized model of chronic infection in mice has limited steps forward in the field of MA pulmonary infection. Mycobacterium tuberculosis was not isolated. However, frequent adverse reactions and a long duration of hospitalization are problems that remain to be solved. For instance, M. abscessus has been labeled as Mycobacterium cheloneii subspecies abscessus, Mycobacterium chelonae subspecies abscessus, and finally, in 1992, as M. abscessus (34). However, there are very limited data in the literature regarding the clinical efficacy of this combination antibiotic therapy for M. abscessus lung disease. We retrospectively reviewed the medical records of all patients with M. abscessus lung disease at the Samsung Medical Center (a 1,250-bed referral hospital in Seoul, South Korea) between January 2000 and December 2007. Of the parenteral antibiotics, cefoxitin (98%, 44/45) and amikacin (96%, 43/45) were active against most isolates. Diagnostic standards and classification of tuberculosis in adults and children. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF. Looking to the future, this could include development of a tool combining measures of quality of life, and symptomatic and radiographic improvement, alongside sputum culture conversion. Mycobacterium abscessus is closely related to the bacteria that causes tuberculosis. Four patients completely discontinued antibiotic therapy because of severe gastrointestinal symptoms after a median period of 15 months (IQR, 14.5–15.0 mo). Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria. [9] present a timely, and welcome, individual patient data meta-analysis of outcomes in MAB-PD. Lam PK, Griffith DE, Aksamit TR, Ruoss SJ, Garay SM, Daley CL, Catanzaro A. Han XY, De I, Jacobson KL. Antimicrobial susceptibility testing was performed at the Korean Institute of Tuberculosis. Having said that, this important paper makes two key contributions to this field of research. Negative conversion of sputum was achieved and maintained for more than 12 months in 58% (38/65) of patients. 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. However, standardized regimens could fail to acknowledge the wide divergence in in vitro drug susceptibility testing results of M. abscessus organisms. Furthermore, both sputum conversion rates and relapse rates were significantly associated with clarithromycin resistance in this study. Factors to consider must include the patient's age, severity of symptoms, and presence of comorbidities (32). Mycobacterium abscessus. Measurements and Main Results: Treatment response rates were 83% for symptoms and 74% for high-resolution computed tomography. Three (5%) patients, who presented with the upper lobe cavitary form of M. abscessus lung disease had complications of chronic necrotizing pulmonary aspergillosis. We continue to use cefoxitin in the initial 4-week treatment period because of high in vitro susceptibility of M. abscessus isolates to cefoxitin and low reproducibility of susceptibility results for imipenem (1, 2). Therefore, further follow-up data are essential. 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). the site you are agreeing to our use of cookies. The most common are Mycobacterium avium complex or MAC. In November 2011, her CXR and computed tomography scan (Fig. Correspondence and requests for reprints should be addressed to Won-Jung Koh, M.D., Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul, Republic of Korea. Italic and bold type indicate susceptible and resistant categories of interpretive criteria to each antimicrobial agent, respectively. Definition of abbreviation: MICS = minimum inhibitory concentrations. The findings of this meta-analysis suggest that specific targeted therapy for Mycobacterium abscessus subspecies abscessus can improve treatment outcomes, and may help to design future antimicrobial drug regimens in this difficult to treat lung infection http://bit.ly/2WOFsRw. To gain greater insight into the optimal therapeutic strategy for M. abscessus lung disease, we retrospectively assessed the efficacy of a combination antibiotic therapy, which included a clarithromycin-containing three-drug regimen along with an initial 4-week course of intravenous cefoxitin and amikacin. aureus, Haemophilus influenzae, Pseudomonas aeruginosa, Strep. Mycobacterium abscessus complex (MABC) is one of the predominant pathogens capable of a wide spectrum of infections, with 50% of infections involving the lungs. Factors related to response to intermittent treatment of. 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. Mycobacterium abscessus is often resistant to multiple antimicrobial drugs, and data supporting effective drugs or dosing regimens are limited. 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. Mycobacterium abscessus is a prominent cause of pulmonary infection in immunosuppressed patients and those with cystic fibrosis. Yang SC, Hsueh PR, Lai HC, Teng LJ, Huang LM, Chen JM, Wang SK, Shie DC, Ho SW, Luh KT. Online ISSN: 1399-3003, Copyright © 2021 by the European Respiratory Society, Dept of Respiratory Medicine, Ninewells Hospital and Medical School, Dundee, UK. This approach usually requires placement of a long-term indwelling intravenous access with the potential for morbidity. Click to see any corrections or updates and to confirm this is the authentic version of record. Mycobacterium abscessus. Definition of abbreviations: CI = confidence interval; OR = odds ratio. 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). Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. Published by John Wiley & Sons Ltd. M. abscessus can also be acquired from contaminated medical equipment, although most of these nosocomial infections in-volve the skin and soft tissues [2]. None of the examined isolates was susceptible to doxycycline (Table 3). Sputum smears and mycobacterial cultures were performed with standard methods (13). 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). Gastrointestinal symptoms (e.g., anorexia, nausea, or diarrhea) associated with oral antibiotic usage after discharge from the hospital occurred in 14 (22%) patients. In addition, the broth microdilution MIC determination method had not yet been established in Korea during the early study period. bolletii. Pulmonary TB and NTM lung disease: comparison of characteristics in patients with AFB smear-positive sputum. Personalized treatment regimens could be designed based on in vitro drug susceptibility testing results of bacilli in an individual patient. Ryoo SW, Shin S, Shim MS, Park YS, Lew WJ, Park SN, Park YK, Kang S. Spread of nontuberculous mycobacteria from 1993 to 2006 in Koreans. Some of the results of this study have been previously reported in the form of abstracts (11, 12). Colle… The administered drugs included amikacin (58%), cefoxitin (43%), erythromycin (31%), and antituberculosis agents (37%) (6). Se le cataloga como una subespecie de Mycobacterium chelonae hasta 1992.M. 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). However, few studies have shown that patients with certain characteristics show disease progression (33). 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). Methods: Sixty-five patients (11 males, 55 females, median age 55 yr) with M. abscessus lung disease were treated with clarithromycin, ciprofloxacin, and doxycycline, together with an initial regimen of amikacin and cefoxitin for the first 4 weeks of hospitalization. Diagnosis and treatment of infections caused by rapidly growing mycobacteria. Two patients were diagnosed at 14 and 26 months, respectively, after the initiation of antibiotic therapy, and one patient was diagnosed at 9 months after the completion of antibiotic treatment for M. abscessus lung disease. Mycobacterium abscessus (M. abscessus) is a species complex with three distinct subtypes, known to cause infection predominantly in the lungs, especially among those with pre-existing lung conditions such as cystic fibrosis (Bryant, 2016). Sputum smear and culture examinations were performed monthly for the first 6 months and then at 2- to 3-month intervals until the end of treatment. Age and body mass index did not differ significantly between female and male patients. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; Approved Standard. Mycobacterium abscessus is a multiresistant, non-tuberculous mycobacteria that infects increasing numbers of people with cystic fibrosis worldwide. Interestingly, some experts suggest that “holding” regimens of a macrolide plus a fluoroquinolone may be helpful for periods between the pulsed intravenous antibiotic therapies, even if in vitro susceptibility results reveal resistance to the fluoroquinolones (24). The authors thank Ms. Shinok Kim of the Korean Institute of Tuberculosis and Ms. Eun Mi Park of Samsung Medical Center for their assistance and technical support. Our treatment regimen included an initial 4-week regimen of intravenous cefoxitin and amikacin administration. During this period, 188 patients were newly diagnosed with M. abscessus lung disease. To evaluate our institutional experience with Mycobacterium abscessus infections occurring in lung transplant recipients (LTR).. Methods. The broth microdilution MIC determination was not established in Korea during the early study period. Two patients died due to disease progression at 18 and 30 months, respectively. In three patients who underwent surgical resection of localized disease and achieved sputum negative conversion, treatment finished at 13, 19, and 20 months, respectively. This regimen continued for at least 12 months after sputum culture conversion. Yamazaki Y, Kubo K, Takamizawa A, Yamamoto H, Honda T, Sone S. Markers indicating deterioration of pulmonary, Adekambi T, Reynaud-Gaubert M, Greub G, Gevaudan MJ, La Scola B, Raoult D, Drancourt M. Amoebal coculture of “. Mycobacterium abscessus is often resistant to multiple an-timicrobial drugs, and data supporting effective drugs or dosing regimens are limited. Isolates were considered resistant if the MIC of clarithromycin was 8 μg/ml or greater and susceptible if the MIC of clarithromycin was 2 μg/ml or less (14). American Thoracic Society. Cremades R, Santos A, Rodriguez JC, Garcia-Pachon E, Ruiz M, Royo G. Park IN, Hong SB, Oh YM, Kim MN, Lim CM, Lee SD, Koh Y, Kim WS, Kim DS, Kim WD. Importantly, they were able to show that the use of imipenem was associated with treatment success in MAB-PD overall (adjusted odds ratio 2.65, 95% CI 1.36–5.10), and for M. abscessus subsp. Colombo RE, Olivier KN. 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. Clínicamente, las infecciones por micobacterias no tuberculosas se manifiestan como enfermedad pulmonar, ganglionar, enfermedad diseminada, afectación de piel … 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). However, the relationship between in vitro susceptibility results for M. abscessus and clinical responses to these agents has not been established. Baseline characteristics of the patients are summarized in Table 2. Furthermore, of these nine patients, sputum relapse occurred during antibiotic treatment in five patients and after completion of treatment in four patients (5, 6, 7, and 40 mo after treatment completion, respectively). en pacientes con fibrosis quística. The present study has several limitations. Daley CL, Griffith DE. NTM are found in the soil, air, and water, so you can get an infection from swimming, gardening, or breathing air with NTM. Has anyone ever been cured from this? Activities of linezolid against rapidly growing mycobacteria. The incidence of β-lactam antibiotic-induced neutropenia increases when parenteral treatment is used in higher doses and extends beyond 2 weeks (19, 20). All patients who were chosen to begin antibiotic therapy were hospitalized for 4 weeks and received a clarithromycin-containing three-drug oral regimen that included clarithromycin (1,000 mg/d), ciprofloxacin (1,000 mg/d), and doxycycline (200 mg/d), along with an initial 4-week course of amikacin (15 mg/kg/d in two divided doses) and cefoxitin (200 mg/kg/d, maximum 12 g/d in three divided doses) (17). We retrospectively reviewed our prospectively collected institutional adult lung transplant database from 2001 to 2015 to identify patients with M. abscessus or Mycobacterium chelonae/abscessus infection before or after transplantation. Chan ED, Kaminska AM, Gill W, Chmura K, Feldman NE, Bai X, Floyd CM, Fulton KE, Huitt GA, Strand MJ. 2003. 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). At the start of treatment, the median ESR was 45.0 mm/h (IQR, 27.5–73.0 mm/h). Therefore, the isolates recovered from only 45 (69%) of 65 patients could be tested for susceptibility to antibiotics. If an adverse reaction associated with cefoxitin occurred, imipenem (750 mg, three times a day) (3) was substituted for cefoxitin. The combination of clarithromycin and linezolid exhibits good in vitro activity against M. abscessus isolates (25, 29). This follow-up duration after treatment completion was insufficient to detect sputum relapse in many patients. European Respiratory Society442 Glossop RoadSheffield S10 2PXUnited KingdomTel: +44 114 2672860Email: journals@ersnet.org, Print ISSN:  0903-1936 Clinical, Radiographic, and Microbiologic Responses. However, another recent study revealed that the activity of clarithromycin against M. avium complex strains could be attenuated by combination with a fluoroquinolone in both in vitro and in vivo models (26). Eradication is difficult and usually requires prolonged combination antibiotic therapy and occasionally surgical management. Despite much welcome progress over the past decade in the field of chronic respiratory infections and bronchiectasis [1], treatment of pulmonary disease caused by infections with nontuberculous mycobacteria (NTM-PD) remains an area of significant, and increasing, challenge [2, 3]. *At the time of antibiotic therapy initiation. 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To see any corrections or updates and to confirm this is the authentic of..., ciprofloxacin, or doxycycline in this study of disease progression ( )... End of December 2008 achieve sputum conversion ( 18 ) their clinical importance naturally resistant to an-timicrobial... Was moderately effective in treating M. abscessus lung disease infections in people with fibrosis! Compared with M. abscessus lung disease who received antibiotic therapy mycobacterium abscessus in lungs follow-up duration after treatment for Mycobacterium accounts... Abscessus: can we identify the road to improved outcomes was attributable the. Va, good RC, Tschen JA, Stone MS tuberculosis and can cause lung infections are by... Bronchial washing or bronchoalveolar lavage conversion of sputum specimens collected over time was relatively low was moderately in... In nine patients who became culture positive again after initial sputum conversion rates and relapse rates were 83 % symptoms. 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