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]. We characterized the lung immune responses in mice and guinea pigs infected with M. abscessus.C57BL/6 and leptin‐deficient ob/ob mice challenged with a low‐dose aerosol (LDA) of M. abscessus did not develop an infection. 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. Jeon K, Koh WJ, Kwon OJ, Lee KS, Park YK. M. abscessus can also be acquired from contaminated medical equipment, although most of these nosocomial infections in-volve the skin and soft tissues [2]. However, the patients did not receive the currently recommended combination of antibiotics, which includes newer macrolides such as clarithromycin. Nam HS, Koh WJ, Kwon OJ, Cho SN, Shim TS. 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. 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). 2) showed further enlarged upper lobe cavities associated with increased adjacent lung infiltrates. Optimal therapeutic regimens have not been established for M. abscessus lung disease. Koh WJ, Kwon OJ, Lee KS. 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). The decision is relatively easy in patients with profound symptoms and destructive lesions; however, the decision is difficult in patients with mild symptoms and non-advanced lesions. *At the time of antibiotic therapy initiation. M. abscessus is resistant to many antibiotics and thus is very difficult to treat. The optimal therapeutic regimen and duration of treatment for M. abscessus lung disease has not been established. pneumoniae, Burkholderia cepacia, and sometimes mycoses or mycobacteria. All patients met the diagnostic criteria for NTM lung disease, according to the ATS guidelines in 1997 (1). 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. The broth microdilution MIC determination was not established in Korea during the early study period. Pulmonary Mycobacterium abscessus: can we identify the road to improved outcomes. An analysis of 154 patients. E-mail: American Journal of Respiratory and Critical Care Medicine. One patient, whose sputum cultures had converted to negative for 18 months, refused further therapy at 19 months. Pulmonary disease caused by Mycobacterium abscessus (MAB-PD) is of particular interest as, when coupled with underlying lung disease, it is associated with rapidly declining lung function, significant morbidity and mortality, and particularly poor treatment outcomes: cure, as generally defined by persistent culture conversion, is generally reported to be found in less than 50% of cases in … Adekambi T, Berger P, Raoult D, Drancourt M. Kim HY, Kook Y, Yun YJ, Park CG, Lee NY, Shim TS, Kim BJ, Kook YH. In a large study of 154 patients with RGM-associated lung disease, in which more than 80% of patients were infected by M. abscessus, Griffith and colleagues concluded that M. abscessus was extremely difficult to eradicate by antibiotic therapy (6). 2 Chan ED, Kaminska AM, Gill W, Chmura K, Feldman NE, Bai X, Floyd CM, Fulton KE, Huitt GA, Strand MJ. Definition of abbreviations: AFB = acid-fast bacilli; IQR = interquartile range. However, frequent adverse reactions and a long duration of hospitalization are problems that remain to be solved. Colle… Recent studies showed that low MIC of clarithromycin was observed for M. massiliense compared with M. abscessus (37, 38). In addition, sputum relapse after initial negative conversion was higher in patients infected with clarithromycin-resistant isolates (60%, 3/5) compared with those infected with clarithromycin-susceptible or intermediate isolates (16%, 4/25). Sputum smears and mycobacterial cultures were performed with standard methods (13). The initial sputum conversion rate was 72% (47/65), and the median time until sputum conversion was 1 month (IQR, 1–1 mo). 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]. ): M. abscessus subsp. MAC encompasses three mycobacterial species known as M. avium,M. Informed consent was waived because of the retrospective nature of the study. 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. The administered drugs included amikacin (58%), cefoxitin (43%), erythromycin (31%), and antituberculosis agents (37%) (6). Mycobacterium abscessus is a prominent cause of pulmonary infection in immunosuppressed patients and those with cystic fibrosis. Surgical resection was performed in 14 (22%) patients. At the start of treatment, the median ESR was 45.0 mm/h (IQR, 27.5–73.0 mm/h). To better identify treatment approaches and associated toxicities, we collected a series of case reports from the Emerging Infections Network. Mycobacterium abscessus is greatly associated with lung infection among patients with bronchiectasis, and is an important cause of morbidity among this patient population. High prevalence of antimicrobial resistance in rapidly growing mycobacteria in Taiwan. A diagnosis in these cases was established via culture from bronchial washing or bronchoalveolar lavage. More than 120 species of mycobacteria have been identified that can cause disease in humans. Pulmonary infections caused by Mycobacterium abscessus (MA) have increased over recent decades, affecting individuals with underlying pathologies such as chronic obstructive pulmonary disease, bronchiectasis and, especially, cystic fibrosis. 1. Mycobacterium abscessus complex (MABC) is one of the predominant pathogens capable of a wide spectrum of infections, with 50% of infections involving the lungs. Therefore, further follow-up data are essential. Introduction. This approach usually requires placement of a long-term indwelling intravenous access with the potential for morbidity. 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). 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). 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 … Wallace RJ Jr, Swenson JM, Silcox VA, Good RC, Tschen JA, Stone MS. Mycobacterium abscessus is often resistant to multiple antimicrobial drugs, and data supporting effective drugs or dosing regimens are limited. 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