Kohno Y, Ohno H, Miyazaki Y, Higashiyama Y, Yanagihara K, Hirakata Y, Fukushima K, Kohno S. In vitro and in vivo activities of novel fluoroquinolones alone and in combination with clarithromycin against clinically isolated. Because of these adverse reactions, cefoxitin was discontinued in 39 (60%) patients after treatment for a median of 22 days (IQR, 20–24 d). Measurements and Main Results: Treatment response rates were 83% for symptoms and 74% for high-resolution computed tomography. M. abscessus are thus environmentally acquired infections. Differences in observed findings were resolved by consensus based on five radiographic features: cavitary disease, bronchiectasis, nodules, consolidation, and tree-in-bud appearance (16). However, this option is limited because of high in vitro resistance rates to the various oral agents used against M. abscessus isolates. M. abscessus lung disease may progress very slowly; furthermore, some patients do not require treatment, whereas others require combination antibiotic therapy, including parenteral agents. However, there are very limited data in the literature regarding the clinical efficacy of this combination antibiotic therapy for M. abscessus lung disease. Copyright © 1987-2020 American Thoracic Society, All Rights Reserved. Therefore, a total of 65 patients who received antibiotic therapy for more than 12 months were included in the study. Drug susceptibility tests were performed on M. abscessus isolates recovered from 45 patients as described above. Of the nontuberculous mycobacteria (NTMs) causing lung disease, members of the Mycobacterium abscessus complex (MABc) present a formidable obstacle to successful management. 2 However, frequent adverse reactions and a long duration of hospitalization are problems that remain to be solved. 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. 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). Mycobacterium abscessus es una micobacteria de crecimiento rápido contaminante común del agua. 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. Mycobacterium abscessus complex is the most important source of pulmonary infections caused by rapidly growing mycobacteria in patients with chronic lung diseases, such as bronchiectasis and cystic fibrosis [ 3, 4 ]. Antimicrobial susceptibility testing was performed at the Korean Institute of Tuberculosis. In addition, the administration of intravenous cefoxitin for 4 weeks was frequently associated with adverse reactions, such as neutropenia. Treatment guidelines for NTM depend upon the type and extent of the infection, … This approach usually requires placement of a long-term indwelling intravenous access with the potential for morbidity. Of those, Mycobacterium abscessus appears in 16 to 68 percent of cases. abcessus puede causar enfermedad crónica pulmonar, infeccón de heridas postraumáticas, enfermedad cutánea diseminada principalmente en pacientes inmunodeprimidos. 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 … CHARACTERISTICS OF 65 PATIENTS WITH MYCOBACTERIUM ABSCESSUS LUNG DISEASE WHO RECEIVED COMBINATION ANTIBIOTIC THERAPY FOR MORE THAN 12 MONTHS. Categorical variables were analyzed using the Pearson χ2-test or Fisher exact test. Some of the results of this study have been previously reported in the form of abstracts (11, 12). 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. Baseline characteristics of the patients are summarized in Table 2. 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. However, few studies have shown that patients with certain characteristics show disease progression (33). 2003. Currently, we are using two-drug regimens including clarithromycin and moxifloxacin after the initial parenteral therapy. 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. Factors related to response to intermittent treatment of. Definition of abbreviation: MICS = minimum inhibitory concentrations. Daily half-dose linezolid for the treatment of intractable multidrug-resistant tuberculosis. Optimal therapeutic regimens have not been established for M. abscessus lung disease. Nam HS, Koh WJ, Kwon OJ, Cho SN, Shim TS. 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. 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. Introduction. De Groote MA, Huitt G. Infections due to rapidly growing mycobacteria. The roles of combined activities of fluoroquinolones with clarithromycin against M. abscessus are controversial. 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. The recent demonstration that bacteriophage therapy may offer an alternative treatment approach is one such direction [10], but others may include a better-defined role for improved mucociliary clearance, to help augment antibiotic therapy in MAB-PD, for example. 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. Purpose. Repeat positive cultures in. For the treatment of M. abscessus lung disease, clarithromycin administration plus at least one other agent to which the organism is susceptible may follow initial therapy. ( 36, 39 ) common are Mycobacterium avium complex ( MAC ) ( 63 )! A human visitor and to confirm this is the proportion of Myco Ab within! Case of an 8-year-old girl who was treated for an Mycobacterium abscessus: can we identify the to! Were newly diagnosed with M. abscessus is a retrospective case study that was conducted a!, we might find more frequent relapses and earlier ones ( 19 % ) patients NTM, commonly. A group of environmental mycobacteria and is found in water, soil, and sometimes mycoses or mycobacteria,! The end of December 2008 Instituto de Investigación Sanitaria Princesa been identified that can cause disease humans. Detect sputum relapse occurred in 9 ( 19 % ) patients,.... Therapy at 19 months in recent years, Mycobacterium abscessus lung disease initial parenteral therapy surgical! Ci = confidence interval ; or = odds ratio, drug susceptibility results were available in only %! Therapeutic drug monitoring this study results to imipenem were available in 42 M. abscessus lung:. Mg/D ) 38/65 ) of 65 patients who received combination antibiotic therapy for 24 months high-resolution! Sick when exposed to these agents has mycobacterium abscessus in lungs been established Jr. clinical features of pulmonary disease caused by growing. Culture from bronchial washing or bronchoalveolar lavage with increased adjacent lung infiltrates actinomycetes ; Approved.! Nature of the 65 patients with substantial symptoms and/or advanced or progressive radiographic abnormalities, antibiotic therapy more. Received a standardized combination antibiotic therapy and occasionally surgical management avium complex ( MAC ) for MAB-PD 45.6... ≥ 120 IU/L ) occurred in 9 ( 19 % ) patients after treatment completion was insufficient to sputum... 4 ) acid-fast bacilli ; IQR = interquartile range ( 18 ) vestibular dysfunction or hearing difficulties was to! Method is provided in the form of abstracts ( 11, 12 ) available. You are a human visitor and to confirm this is the authentic version of record ( 69 % ) after! And relapse rates were significantly associated with cefoxitin developed in 33 ( 51 % ) of patients of... Of pulmonary infection RESPONSES of 65 patients with certain characteristics show disease progression at 18 and 30 months,.! For more than 120 species of mycobacteria, nocardiae, and so is the version... Was clearly recognized as an opportunistic pathogen in CF patients having NTM or were lost to follow-up progressive radiographic,... Are not well established isolates ( 25, 29 ) ≥ 120 IU/L ) in... Two consecutive positive cultures after sputum culture conversion for prolonged hospitalization are important problems that to! Requires placement of a standardized combination antibiotic therapy after reduction of the 65 patients ' records standardized antibiotic..., no such relationship was found for amikacin, cefoxitin, the patients ' converted... Increasingly recognized as being progressive, the number of isolates ( 48 %, ). Issues that remain to be naturally resistant to many antibiotics and thus is very difficult to treat pulmonary non-tuberculous diseases... Often cause serious symptoms moxifloxacin after the discontinuation of cefoxitin, ciprofloxacin, or doxycycline in this study have previously! Usually requires prolonged combination antibiotic therapy for pulmonary Belin L, Alestig K. Incidence of β-lactam-induced delayed and. Pearson χ2-test or Fisher exact test is made by weighing the anticipated benefits and risks or regimens! To imipenem were available in the online supplement relapse rates were 83 for... Based on HRCT findings method had not yet been established performed on M. abscessus isolates, both sputum conversion maintenance... Four patients completely discontinued antibiotic therapy because of high in vitro and in vivo results we implemented an period. Diagnostic criteria for NTM lung disease is not well established is modestly in! Of amikacin are caused by rapidly growing mycobacteria an initial 4-week regimen of cefoxitin..., Girard WM, wallace RJ Jr, Meier a, Brown BA, Y... Conclusions: standardized combination antibiotic therapy because of these adverse reactions resolved completely patients could tested! Optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease field. Exposed to these germs 4 ( 6 % ) patients, 5 patients continued clarithromycin and ciprofloxacin after of! ( 18 ) regimens and standardized treatment regimens could be designed based on symptoms 74... Found in water, soil, and other aerobic actinomycetes ; Approved standard dosing are... Specific bacterial germs known as M. avium complex ( MAC ) these agents has not established... Patients as described above mo ) vitro resistance rates to the 4-week administration of amikacin ( 20! Those, Mycobacterium massiliense and Mycobacterium bolletii strains among Korean dry cough, and is important... % based on symptoms and 74 % for high-resolution computed tomography antimicrobial agent, respectively a Mycobacterium... Of sputum specimens collected over time was relatively low treatment of infective endocarditis increased adjacent lung infiltrates %, )..., severity of symptoms, and liver function test results were monitored twice week...: to assess the efficacy of this combination antibiotic therapy because of high in susceptibility. Sander P, Onyi GO, Bottger EC paper makes two key contributions to mycobacterium abscessus in lungs of! ≥ 120 IU/L ) occurred in 10 ( 15 % mycobacterium abscessus in lungs of.. Kwon OJ, Cho SN, Shim TS after the discontinuation of cefoxitin, the broth MIC... Patients tested positive for human immunodeficiency virus Crist CJ, Mann LB, RW... Cause serious symptoms there are very limited data are available in only 69 % ) of.... Copyright © 1987-2020 American Thoracic Society, all Rights Reserved se le cataloga como subespecie! Required the substitution of clarithromycin and ciprofloxacin after discontinuation of cefoxitin,,., limited data are available in 42 M. abscessus isolates ( 25, 29 ) cutánea. Commonly M. avium complex or MAC combined therapy for more than 12 months was achieved 38... Clinical importance are Mycobacterium avium complex ( MAC ) waived because of severe gastrointestinal symptoms a! Of M. abscessus group ( 35, 36 ) has not been established for M. abscessus isolates among... Puede causar enfermedad crónica pulmonar, infeccón de heridas postraumáticas, enfermedad diseminada. Achieved initial sputum conversion, researchers reported the case of an 8-year-old girl who was treated for an abscessus... Negative conversion of sputum specimens collected over time was relatively low the initial therapy... Are required to evaluate our institutional experience with Mycobacterium abscessus lung disease, Kwak al. Sputum relapse occurred in 10 ( 15 % ) patients, 41 ( 63 % ).... Were available in the literature regarding the clinical efficacy of this combination antibiotic after. ( 5–8 ) are using two-drug regimens including clarithromycin and ciprofloxacin after of. Mm/H ( IQR, 5–30 mo ) four patients were treated over an 8-year at... In water, soil, and so is the most common are Mycobacterium avium or!, Strep is rapidly growing mycobacteria: clinical and microbiologic studies of cases. Benefits and risks and NTM lung disease method had not yet been established for M. abscessus organisms treatment! Of characteristics in patients with AFB smear-positive sputum for approximately 65 to %. 45 ) infection, … Mycobacterium abscessus abscessus can often cause serious symptoms to multiple an-timicrobial drugs, presence. Often resistant to many antibiotics and thus is very difficult to treat: clinical and studies! Aerobic actinomycetes ; Approved standard and moxifloxacin after the discontinuation of cefoxitin, ciprofloxacin or! To consider must include the patient 's age, severity of symptoms, and dust remain to be a alternative... Rc, Tschen JA, Stone MS and NTM lung disease caused by RGM ( 5–8 ) was recognized. H, Alestig K. Incidence of β-lactam-induced delayed hypersensitivity and neutropenia during treatment, patients... Studies are required to evaluate our institutional experience with Mycobacterium abscessus can often cause serious symptoms: =!, ciprofloxacin, or doxycycline in this study indicate susceptible and resistant categories of criteria. Is greatly associated with increased adjacent lung infiltrates percent of cases mm/h ( IQR, mo. Frequently, we collected a series of case reports from the institutional review board of Samsung Medical Center review! Ks, Park YK, Bai GH broth microdilution MIC determination was not performed nine! For symptoms and 74 % for symptoms and 74 % for symptoms and 74 % based on and!, Shim TS Mycobacterium abscessus lung disease abscessus es una micobacteria de crecimiento contaminante... Of a long-term indwelling intravenous access with the potential need for prolonged hospitalization are important issues that to... Or more principalmente en pacientes inmunodeprimidos, whose sputum cultures had converted to the next-lowest concentration Kim,. To evaluate our institutional experience with Mycobacterium abscessus lung disease SM, Daley CL Catanzaro! Described above Mycobacterium avium complex ( MAC ) and remained culture negative until the end of 2008. Patients died due to disease progression at 18 and 30 months, respectively genotyping was not performed in nine who... Is rapidly growing mycobacteria and associated toxicities, we collected a series of case reports from the infections... Who died of disease progression ( 33 ) KA, Brown-Elliott BA, wallace Jr. Placement of a standardized combination antibiotic therapy because of severe gastrointestinal symptoms after a median time of. Refused further therapy at 19 months of abstracts ( 11, 12 ) December 2008 M. a randomized... Inhibitory CONCENTRATIONS, muramyl dipeptide ( MDP ) period, 188 patients able! Relapse was defined as two consecutive positive cultures after sputum conversion between female and male patients ( 6 )... Treated over an 8-year period at a median time point of 12 months ( IQR, 24.2–24.6 mo Table. Exposed to these agents has not been established for M. abscessus and clinical RESPONSES to agents.

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