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Clinical Characteristics and Treatment Outcomes of Patients with Macrolide-Resistant Mycobacterium massiliense Lung Disease

Authors
 Hayoung Choi  ;  Su-Young Kim  ;  Hyun Lee  ;  Byung Woo Jhun  ;  Hye Yun Park  ;  Kyeongman Jeon  ;  Dae Hun Kim  ;  Hee Jae Huh  ;  Chang-Seok Ki  ;  Nam Yong Lee  ;  Seung-Heon Lee  ;  Sung Jae Shin  ;  Charles L. Daley  ;  Won-Jung Koh 
Citation
 ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Vol.61(2) : e02189-16, 2017 
Journal Title
 ANTIMICROBIAL AGENTS AND CHEMOTHERAPY 
ISSN
 0066-4804 
Issue Date
2017
MeSH
Adolescent ; Adult ; Aged ; Anti-Bacterial Agents/pharmacology* ; Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Lung Diseases/microbiology* ; Macrolides/pharmacology* ; Macrolides/therapeutic use ; Male ; Middle Aged ; Mycobacterium/drug effects* ; Mycobacterium/pathogenicity ; Mycobacterium Infections/drug therapy ; Mycobacterium Infections/microbiology ; Mycobacterium avium Complex/drug effects ; Mycobacterium avium Complex/pathogenicity ; Retrospective Studies ; Treatment Outcome ; Young Adult
Abstract
Macrolide antibiotics are cornerstones in the treatment of Mycobacterium massiliense lung disease. Despite the emergence of resistance, limited data on macrolide-resistant M massiliense lung disease are available. This study evaluated the clinical features and treatment outcomes of patients and the molecular characteristics of macrolide-resistant M massiliense isolates. We performed a retrospective review of medical records and genetic analyses of clinical isolates from 15 patients who had macrolide-resistant M massiliense lung disease between September 2005 and February 2015. Nine patients (60%) had the nodular bronchiectatic form of the disease, and six (40%) had the fibrocavitary form. Before the detection of macrolide resistance, three patients (20%) were treated with macrolide monotherapy, four (27%) with therapy for presumed Mycobacterium avium complex infections, and eight (53%) with combination antibiotic therapy for M massiliense lung disease. The median treatment duration after the detection of resistance was 18.7 months (interquartile range, 11.2 to 39.8 months). Treatment outcomes were poor, with a favorable outcome being achieved for only one patient (7%), who underwent surgery in addition to antibiotic therapy. The 1-, 3-, and 5-year mortality rates were 7, 13, and 33%, respectively. Of the 15 clinical isolates, 14 (93%) had point mutations at position 2058 (n = 9) or 2059 (n = 5) of the 23S rRNA gene, resulting in macrolide resistance. Our study indicates that treatment outcomes are poor and mortality rates are high after the development of macrolide resistance in patients with M massiliense lung disease. Thus, preventing the development of macrolide resistance should be a key consideration during treatment.
Files in This Item:
T201703533.pdf Download
DOI
10.1128/AAC.02189-16
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실) > 1. Journal Papers
Yonsei Authors
Shin, Sung Jae(신성재) ORCID logo https://orcid.org/0000-0003-0854-4582
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160883
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