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Mycobacterial Characteristics and Treatment Outcomes in Mycobacterium abscessus Lung Disease

 Won-Jung Koh  ;  Byeong-Ho Jeong  ;  Su-Young Kim  ;  Kyeongman Jeon  ;  Kyoung Un Park  ;  Byung Woo Jhun  ;  Hyun Lee  ;  Hye Yun Park  ;  Dae Hun Kim  ;  Hee Jae Huh  ;  Chang-Seok Ki  ;  Nam Yong Lee  ;  Hong Kwan Kim  ;  Yong Soo Choi  ;  Jhingook Kim  ;  Seung-Heon Lee  ;  Chang Ki Kim  ;  Sung Jae Shin  ;  Charles L. Daley  ;  Hojoong Kim  ;  O. Jung Kwon 
 CLINICAL INFECTIOUS DISEASES, Vol.64(3) : 309-316, 2017 
Journal Title
Issue Date
Aged ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use* ; Clarithromycin/pharmacology ; Clarithromycin/therapeutic use ; Drug Resistance, Microbial ; Female ; Genotype ; Humans ; Lung Diseases/drug therapy* ; Lung Diseases/microbiology* ; Male ; Middle Aged ; Mycobacterium Infections, Nontuberculous/drug therapy* ; Mycobacterium Infections, Nontuberculous/microbiology* ; Nontuberculous Mycobacteria*/classification ; Nontuberculous Mycobacteria*/drug effects ; Nontuberculous Mycobacteria*/genetics ; Nontuberculous Mycobacteria*/isolation & purification ; Recurrence ; Retrospective Studies ; Sputum/microbiology ; Treatment Outcome
Mycobacterium abscessus ; lung disease ; macrolides ; nontuberculous mycobacteria
BACKGROUND: Treatment outcomes of patients with Mycobacterium abscessus subspecies abscessus lung disease are poor, and the microbial characteristics associated with treatment outcomes have not been studied systematically. The purpose of this study was to identify associations between microbial characteristics and treatment outcomes in patients with M. abscessus lung disease.

METHODS: Sixty-seven consecutive patients with M. abscessus lung disease undergoing antibiotic treatment for ≥12 months between January 2002 and December 2012 were included. Morphotypic and genetic analyses were performed on isolates from 44 patients.

RESULTS: Final sputum conversion to culture negative occurred in 34 (51%) patients. Compared to isolates from 24 patients with persistently positive cultures, pretreatment isolates from 20 patients with final negative conversion were more likely to exhibit smooth colonies (9/20, 45% vs 2/24, 8%; P = .020), susceptibility to clarithromycin (7/20, 35% vs 1/24, 4%; P = .015), and be of the C28 sequevar with regard to the erm(41) gene (6/20, 30% vs 1/24, 4%; P = .035). Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. Genotypic analysis revealed that most episodes (22/24, 92%) of persistently positive cultures during antibiotic treatment and all cases of microbiologic recurrence after treatment completion were caused by different M. abscessus genotypes within a patient.

CONCLUSIONS: Precise identification to the subspecies level and analysis of mycobacterial characteristics could help predict treatment outcomes in patients with M. abscessus lung disease. Treatment failures and recurrences are frequently associated with multiple genotypes, suggesting reinfection.
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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
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