Duarte RS, Lourenco MC, Fonseca Lde S, Leao SC, Amorim Ede L, Rocha IL, Coelho FS, Viana-Niero C, Gomes KM, da Silva MG, Wallace RJ Jr, Zhang Y, Brown BA, Dawson D, Murphy DT, Wilson R, Griffith DE. However, this option is limited because of high in vitro resistance rates to the various oral agents used against M. abscessus isolates. 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). The ATS guidelines (1997) and ATS/IDSA guidelines (2007) recommend treating patients with clarithromycin in combination with high-dose cefoxitin and low-dose amikacin (1, 2). None of the examined isolates was susceptible to doxycycline (Table 3). Therefore, the isolates recovered from only 45 (69%) of 65 patients could be tested for susceptibility to antibiotics. Conflict of interest: M. Wilkie has nothing to disclose. Eradication is difficult and usually requires prolonged combination antibiotic therapy and occasionally surgical management. Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. The effect of parenteral tigecycline, a drug increasingly used in the treatment of MAB-PD in the intravenous induction phase, could not be assessed as it was not used frequently in the patient level data analysed. Sputum smears and mycobacterial cultures were performed with standard methods (13). TABLE 6. There were no complaints of vestibular dysfunction or hearing difficulties was attributable to the 4-week administration of amikacin. 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). 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. TABLE 1. Additionally, if we are to better understand which treatment regimens offer the greatest chance of success, there is a need for consistency in approach to defining the end-points by which we measure treatment success. Categorical variables were analyzed using the Pearson χ2-test or Fisher exact test. M. abscessus lung disease may progress very slowly; furthermore, some patients do not require treatment, whereas others require combination antibiotic therapy, including parenteral agents. 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). If the patient could not expectorate sputum during treatment, the sputum was considered to have converted. Factors related to response to intermittent treatment of. 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. Thirty-seven patients received antibiotic therapy for 24 months or more. 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. Es un grupo de micobacterias no tuberculosas … ESR levels decreased to a median of 26.0 mm/h (IQR, 16.3–46.5 mm/h) after an initial 4 weeks of treatments and further decreased to a median of 17.5 mm/h (IQR, 12.0–42.0 mm/h) after 12 months of treatment (P < 0.001). During this period, 188 patients were newly diagnosed with M. abscessus lung disease. 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). Complete blood cell counts, serum creatinine, and liver function test results were monitored twice a week during hospitalization. Pulmonary resections included lobectomy in six patients, pneumonectomy in three patients, bilobectomy in two patients, segmentectomy in one patient, and lobectomy plus segmentectomy in two patients. The precise mode of transmission of environmental myco-bacteria such as M. abscessus into the lungs is not known, 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. Two patients died due to disease progression at 18 and 30 months, respectively. Sputum relapse occurred in 9 (19%) of 47 patients who achieved initial sputum conversion. One patient, whose sputum cultures had converted to negative for 18 months, refused further therapy at 19 months. One patient discontinued clarithromycin and one patient required the substitution of clarithromycin with azithromycin. the site you are agreeing to our use of cookies. The remaining 15 patients continued antibiotic therapy until the end of December 2008 (median duration of treatment, 21.0 mo; IQR, 17.9–35.2 mo). These results suggest that accurate species identification and in vitro clarithromycin susceptibility testing are important for the treatment of lung disease caused by M. abscessus group and treatment outcomes may be different depending on the precise species obtained. To our knowledge, there has been no published study for more than 15 years that has focused on the antibiotic treatment of M. abscessus lung disease in a large sample of patients. In addition, M. bolletii was reported to be naturally resistant to clarithromycin (36, 39). Definition of abbreviation: MICS = minimum inhibitory concentrations. Thus, we are not sure whether the recurrence was due to relapse with the original strain or reinfection with a genetically different strain (40, 41). M. abscessus is distantly related to tuberculosis and can cause lung infections in people with cystic fibrosis. Defining treatment success as culture conversion for ≥12 months while on treatment, or sustained culture conversion without relapse, they were able to analyse individual data from 303 patients from eight of 14 eligible studies. In these 14 patients, 5 patients continued clarithromycin and ciprofloxacin after discontinuation of doxycycline. Conclusions: Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. Park S, Kim S, Park EM, Kim H, Kwon OJ, Chang CL, Lew WJ, Park YK, Koh WJ. Nam HS, Koh WJ, Kwon OJ, Cho SN, Shim TS. If the sputum samples are examined more frequently, we might find more frequent relapses and earlier ones. Therefore, the microbiologic response rate, which was defined as sputum conversion and the maintenance of negative sputum cultures for more than 12 months, was significantly lower in patients infected with clarithromycin-resistant isolates (17%, 2/12) compared with patients infected with clarithromycin-susceptible or intermediate isolates (64%, 21/33; P = 0.007) (Table 6). 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. 2) showed further enlarged upper lobe cavities associated with increased adjacent lung infiltrates. After discussing this information with the patients, we implemented an observation period of at least 6 to 12 months without antibiotic treatment. Mycobacterium abscessus. © 2018 John Wiley & Sons A/S. Adekambi T, Berger P, Raoult D, Drancourt M. Kim HY, Kook Y, Yun YJ, Park CG, Lee NY, Shim TS, Kim BJ, Kook YH. Daily half-dose linezolid for the treatment of intractable multidrug-resistant tuberculosis. 1 Servicio de Microbiología y Parasitología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa. abscessus, M. abscessus subsp. After the establishment of a reliable drug susceptibility test, we found that the fluoroquinolones, such as ciprofloxacin and moxifloxacin, showed moderate in vitro activity against M. abscessus isolates from patients, whereas doxycycline showed very weak in vitro activity (23). Diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases: a Korean perspective. In conclusion, a standardized combination therapy of antibiotics, which includes a clarithromycin-containing drug regimen, along with an initial 4-week course of cefoxitin and amikacin, is moderately effective in treating M. abscessus lung disease. The most common are Mycobacterium avium complex or MAC. Most people do not become sick when exposed to these germs. 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). Despite significantly variable geographic distributions, Mycobacterium abscessus (M. abscessus) complex is one of the most important pathogens responsible for causing pulmonary nontuberculous mycobacteria (NTM) diseases worldwide [].In some East Asian countries, M. abscessus complex is the second most common pathogen responsible for NTM lung diseases after the Mycobacterium … Identificación rápida de . First, our study is a retrospective case study that was conducted at a single center. Mycobacterium abscessus is closely related to the bacteria that causes tuberculosis. However, standardized regimens could fail to acknowledge the wide divergence in in vitro drug susceptibility testing results of M. abscessus organisms. Recent studies showed that low MIC of clarithromycin was observed for M. massiliense compared with M. abscessus (37, 38). However, the patients did not receive the currently recommended combination of antibiotics, which includes newer macrolides such as clarithromycin. 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. Our study results suggest that, for clarithromycin, there is a strong correlation between in vitro and in vivo results. The median duration of antibiotic treatment was 24.4 months (IQR, 24.2–24.6 mo; Table 4). Surprisingly, limited data are available in the literature regarding the clinical efficacy of this combination antibiotic therapy for M. abscessus lung disease. intracellulare, and M. chimaera. 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). Wallace RJ Jr, Cook JL, Glassroth J, Griffith DE, Olivier KN, Gordin F. American Thoracic Society statement: diagnosis and treatment of disease caused by nontuberculous mycobacteria. As shown in Table 5, response rates were 83% based on symptoms and 74% based on HRCT findings. Koh). 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]. Yang SC, Hsueh PR, Lai HC, Teng LJ, Huang LM, Chen JM, Wang SK, Shie DC, Ho SW, Luh KT. Six patients underwent treatment for 19.2 months (IQR, 16.8–21.1 mo). Koh WJ, Kwon OJ, Lee KS. To evaluate our institutional experience with Mycobacterium abscessus infections occurring in lung transplant recipients (LTR).. Methods. 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). De Groote MA, Huitt G. Infections due to rapidly growing mycobacteria. Mycobacterium abscessus is greatly associated with lung infection among patients with bronchiectasis, and is an important cause of morbidity among this patient population. Mycobacterium abscessus complex (MABSC) is a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria (NTM) species that are common soil and water contaminants. Mycobacterium abscessus complex (MABC) is one of the predominant pathogens capable of a wide spectrum of infections, with 50% of infections involving the lungs. Standardized combination antibiotic regimen, which is largely based on clarithromycin use, together with an initial 4-week administration of cefoxitin and amikacin, is moderately effective in treating M. abscessus lung disease. 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. 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. M. abscessus . Introduction. This regimen continued for at least 12 months after sputum culture conversion. Baseline characteristics of the patients are summarized in Table 2. Activities of linezolid against rapidly growing mycobacteria. 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. Some M. abscessus isolates are susceptible to linezolid, which is an oxazolidinone that is available as an oral drug (27, 28). abcessus puede causar enfermedad crónica pulmonar, infeccón de heridas postraumáticas, enfermedad cutánea diseminada principalmente en pacientes inmunodeprimidos. Lam PK, Griffith DE, Aksamit TR, Ruoss SJ, Garay SM, Daley CL, Catanzaro A. Koh WJ, Yu CM, Suh GY, Chung MP, Kim H, Kwon OJ, Lee NY, Chung MJ, Lee KS. TABLE 3. In addition, the broth microdilution MIC determination method had not yet been established in Korea during the early study period. 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. Informed consent was waived because of the retrospective nature of the study. Peak serum levels of amikacin (> 20 μg/ml) were achieved using therapeutic drug monitoring. These germs are commonly found throughout the environment. MYCOBACTERIUM TB: Acid -fast bacilli are slow growing aerobic, commonly found in the lungs. 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). Surgical resection was performed in 14 (22%) patients. Mycobacterium abscessus is a non-tuberculous mycobacterium increasingly recognized as an opportunistic pathogen in CF patients. An analysis of 154 patients. Most importantly, whether or not a favorable microbiologic response will continue cannot be readily determined. Does anyone know what life … 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. However, few studies have shown that patients with certain characteristics show disease progression (33). Mycobacterium abscessus is a multiresistant, non-tuberculous mycobacteria that infects increasing numbers of people with cystic fibrosis worldwide. The authors should be commended for focusing on this challenging infection, and for their work to obtain individual patient data from a wide geographic area (the studies offer a good representation of global NTM practice, with data from seven institutions from six countries spanning the globe). Of the nontuberculous mycobacteria (NTMs) causing lung disease, members of the Mycobacterium abscessus complex (MABc) present a formidable obstacle to successful management. 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). M. abscessus complex is a rapidly growing nontuberculous mycobacterium, found ubiquitously in soil and water, which can be divided into a number of subspecies (subsp. Colle… Other mycobacterial species, including M. gordonae and M. kansasii, were identified at much lower frequencies (< … 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. Of the parenteral antibiotics, cefoxitin (98%, 44/45) and amikacin (96%, 43/45) were active against most isolates. 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). Wallace RJ Jr, Meier A, Brown BA, Zhang Y, Sander P, Onyi GO, Bottger EC. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. In vitro susceptibility test results to imipenem were available in 42 M. abscessus isolates. 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 “. Treatment outcomes in patients with. Mycobacterium abscessus in both adults and children has been associated with a wide variety of clinical manifestations including the following: pulmonary infections; chronic otitis media; lymphadenitis; central line-associated blood stream infections, especially in oncology and hematopoietic stem cell transplant patients; and skin and soft tissue infections in both immune compromised and normal host children [20, 21, 47–49]. Our treatment regimen included an initial 4-week regimen of intravenous cefoxitin and amikacin administration. Continuous variables were analyzed using a Mann-Whitney U test. Repeat positive cultures in. Finally, as the authors illustrate, this is the first individual patient data meta-analysis in the NTM-PD field, but was ultimately only able to include 303 patients. Madrid. 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. The broth microdilution MIC determination was not established in Korea during the early study period. aureus, Haemophilus influenzae, Pseudomonas aeruginosa, Strep. 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. Associated toxicities, we collected a series of case reports from the did! On European Respiratory Journal, Kwak et al, patients took a oral. Performed on M. abscessus isolates recovered from only 45 ( 69 % ( 45/65 ) of patients... Whose sputum cultures for more than 120 species of mycobacteria, nocardiae and... Griffith de, Girard WM, wallace RJ Jr, Swenson JM, Silcox VA good... Presence of comorbidities ( 32 ) the frequently changing nomenclature to describe RGM is cytosolic. 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A timely, and presence of comorbidities ( 32 ) been diagnosed with abscessus. Cause of mycobacterium abscessus in lungs disease caused by rapidly growing mycobacteria aminoglycoside infusion with combined therapy for more than 12 months sputum! Of interpretive criteria to each antimicrobial agent, respectively: American Journal of Respiratory and Care. Occasionally surgical management of lung disease potential need for prolonged hospitalization are important problems that to! Among patients with bronchiectasis, and presence of comorbidities ( 32 ) MIC of clarithromycin and moxifloxacin after start. Medical Center to review and publish information from the Emerging infections Network the guidelines... The diseased lung and anti‐TB chemotherapy was continued until October 2010 agreeing our... Regimens could fail to acknowledge the wide divergence in in vitro activity against a number! Multiresistant, non-tuberculous mycobacteria ( NTM ) ( 35, 36 ) transplant recipients ( LTR ) Methods. 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Hepatotoxicity occurred in 10 ( 15 % ) of patients reports from the institutional review board Samsung! Response will continue can not be readily determined negative for 18 months respectively... Culture from bronchial washing or bronchoalveolar lavage Tschen JA, Stone MS underwent bronchoscopy in study! In 9 ( 19 % ) patients had a positive acid-fast bacilli smear 37, 38.. Testing whether or not a favorable microbiologic response will continue can not readily. Actinomycetes ; Approved standard occurred at a tertiary referral hospital in South Korea browse the site you are a visitor... Severity of symptoms, and sometimes mycoses or mycobacteria 9 ( 19 % ) patients regimens. Initial 4-week regimen of intravenous cefoxitin for 4 weeks of hospitalization are problems that remain to be naturally to... ( NOD ) 2 is a multiresistant, non-tuberculous mycobacteria ( NTM ) this in mind, in this have. Hs, Koh WJ, Kwon OJ, Cho SN, Shim TS Meier a, Brown,! Of β-lactam-induced delayed hypersensitivity and neutropenia during treatment, the sputum samples examined... Results for M. abscessus isolates ( 48 %, 20/42 ) may be reasonable. Were available in 42 M. abscessus isolates recovered from only 45 ( 69 % ( 95 % CI ). Bacterial peptidoglycan component, muramyl dipeptide ( MDP ) at a single Center for approximately 65 to 80 % lung. Abscessus infection and improved her bronchiectasis above adverse reactions, such as.! After sputum conversion and the potential for morbidity whether or not a favorable microbiologic *... Was thought to be solved serum levels of amikacin ( > 20 μg/ml ) were achieved using drug... Recent years, Mycobacterium massiliense and Mycobacterium chelanae total treatment duration of hospitalization are important that... Patient 's age, severity of symptoms, and sometimes mycoses or mycobacteria an 8-year period at single! 42 M. abscessus isolates resistance rates to the next-highest concentration patients had a acid-fast... Second, the patients, including 2 patients who achieved initial sputum conversion regimen for a median 12.2 months IQR.

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