*At the time of antibiotic therapy initiation. Other mycobacterial species, including M. gordonae and M. kansasii, were identified at much lower frequencies (< … Our study results suggest that, for clarithromycin, there is a strong correlation between in vitro and in vivo results. Adverse reactions associated with cefoxitin occurred frequently. Madrid. But perhaps more importantly, it shows that if nihilism is no longer the right answer, then we must also be better at framing new questions in the search for a roadmap to better therapies for our patients with MAB-PD (and indeed NTM-PD more broadly). Definition of abbreviations: AFB = acid-fast bacilli; IQR = interquartile range. MYCOBACTERIUM TB: Acid -fast bacilli are slow growing aerobic, commonly found in the lungs. Patients who received antibiotic therapy tended to be younger and mostly female and were more likely to have respiratory symptoms, positive sputum specimens based on acid-fast bacilli smears, and cavitation on chest radiography, compared with those who did not receive antibiotic therapy (Table 1). 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. For definition of abbreviations, see Table 1. Sputum smears and mycobacterial cultures were performed with standard methods (13). To better identify treatment ap-proaches and associated toxicities, we collected a series of case reports from the Emerging Infections Network. Peak serum levels of amikacin (> 20 μg/ml) were achieved using therapeutic drug monitoring. However, few studies have shown that patients with certain characteristics show disease progression (33). 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. Most people do not become sick when exposed to these germs. First, our study is a retrospective case study that was conducted at a single center. Mycobacterium abscessus. 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 … Chronic lung disease as a result of Mycobacterium abscessus is an emerging infection in the United States. Their intrinsic and easily acquired resistance to commonly used antibiotics (macrolides) make them naturally difficult to treat, as such antibiotics form the cornerstone of most treatment regimens used worldwide. Three patients were able to continue antibiotic therapy after reduction of the clarithromycin dosage (500 mg/d). Mycobacterium abscessus is closely related to the bacteria that causes tuberculosis. 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. Wallace RJ Jr, Meier A, Brown BA, Zhang Y, Sander P, Onyi GO, Bottger EC. Neutropenia and thrombocytopenia associated with cefoxitin developed in 33 (51%) and 4 (6%) patients, respectively. Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene. National Committee for Clinical Laboratory Standards. As shown in Table 5, response rates were 83% based on symptoms and 74% based on HRCT findings. Koh WJ, Yu CM, Suh GY, Chung MP, Kim H, Kwon OJ, Lee NY, Chung MJ, Lee KS. Wallace RJ Jr, Brown-Elliott BA, Ward SC, Crist CJ, Mann LB, Wilson RW. To better identify treatment approaches and associated toxicities, we collected a series of case reports from the Emerging Infections Network. Residual bias, and the dangers of multiple testing in small cohorts, mean that one must still interpret these findings with a degree of caution. Two patients died due to disease progression at 18 and 30 months, respectively. Conclusions: Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. 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. Leukopenia (white blood cell counts < 3,000/μl) and thrombocytopenia (platelet counts < 100,000/μl) developed in 33 (51%) and 4 (6%) patients, respectively. Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. After discharge, patients took a three-drug oral regimen for a total treatment duration of 24 months. However, when challenged with a high‐dose aerosol (HDA), … Age and body mass index did not differ significantly between female and male patients. In 28 of these 39 patients, imipenem was administered as a substitute for cefoxitin during the remaining 4 weeks of hospitalization. Proportions of Mycobacterium massiliense and Mycobacterium bolletii strains among Korean. 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). Of 86 (46%) patients who initiated combination antibiotic therapy, 21 patients were excluded because they had received antibiotic therapy for less than 12 months at the time of analysis. 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). During this period, 188 patients were newly diagnosed with M. abscessus lung disease. TABLE 5. In these 14 patients, 5 patients continued clarithromycin and ciprofloxacin after discontinuation of doxycycline. Koh). If the patient could not expectorate sputum during treatment, the sputum was considered to have converted. Wayne, PA: NCCLS. Thus, the nomenclature of M. abscessus in the present study was referred to the M. abscessus group, which is now divided into three species: M. abscessus, M. massiliense and M. bolletii. Pulmonary TB and NTM lung disease: comparison of characteristics in patients with AFB smear-positive sputum. Third, bacterial genotyping was not performed in nine patients who became culture positive again after initial sputum conversion. 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). 1. Currently, we are using two-drug regimens including clarithromycin and moxifloxacin after the initial parenteral therapy. ): M. abscessus subsp. A positive culture for Aspergillus fumigatus from sputum samples and clinical and radiographic evidence of a chronic infective process were recognized in all three patients. However, there are very limited data in the literature regarding the clinical efficacy of this combination antibiotic therapy for M. abscessus lung disease. Polyclonal, Wallace RJ Jr, Zhang Y, Brown-Elliott BA, Yakrus MA, Wilson RW, Mann L, Couch L, Girard WM, Griffith DE. 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. The optimal therapeutic regimen and duration of treatment for M. abscessus lung disease has not been established. 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. 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). Thus, further studies are required to evaluate active combinations of oral antibiotics and determine their clinical importance. Forty-eight (74%) patients had the nodular bronchiectatic form, 15 (23%) had the upper lobe cavitary form, and 2 (3%) had unclassifiable variants. Most importantly, whether or not a favorable microbiologic response will continue cannot be readily determined. 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. Purpose. 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. Drug susceptibility tests were performed on M. abscessus isolates recovered from 45 patients as described above. Fifty-seven (88%) patients had a positive acid-fast bacilli smear. For instance, M. abscessus has been labeled as Mycobacterium cheloneii subspecies abscessus, Mycobacterium chelonae subspecies abscessus, and finally, in 1992, as M. abscessus (34). This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Nontuberculous mycobacterial (NTM) lung infections are caused by NTM, most commonly M. avium complex (MAC). Es un grupo de micobacterias no tuberculosas … M. abscessus . Mycobacterium abscessus complex is an ubiquitous, rapidly growing mycobacterium.1,2 The lungs are the most frequent site of infection, and M. abscessus infections progress slowly if left untreated.1,4 A history of chronic cough is often present initially, whereas fever and constitutional symptoms are seen with In South Korea, M. abscessus is the second most common pathogen responsible for lung disease caused by nontuberculous mycobacteria (NTM), after Mycobacterium avium-intracellulare complex (9, 10). This approach usually requires placement of a long-term indwelling intravenous access with the potential for morbidity. 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. *Low off-scale MICs were converted to the next-lowest concentration. 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. ATS/IDSA recommendations suggest that susceptibility to some agents, such as amikacin, cefoxitin, clarithromycin, ciprofloxacin, and doxycycline, should be reported and used to guide treatment (1, 2). Continuous variables were analyzed using a Mann-Whitney U test. 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. 2 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. Informed consent was waived because of the retrospective nature of the study. The other 18 (28%) patients, including 2 patients who died of disease progression, failed to achieve sputum conversion. We retrospectively reviewed the medical records of all patients with M. abscessus lung disease at the Samsung Medical Center (a 1,250-bed referral hospital in Seoul, South Korea) between January 2000 and December 2007. We used a clarithromycin-containing three-drug oral regimen because of our concern for the emergence of clarithromycin resistance during clarithromycin monotherapy after discharge from the hospital after the initial 4-week therapy (21, 22). Surgical resection was performed in 14 (22%) patients. A nonparametric repeated-measures analysis of variance (Friedman test) was performed to test for changes in erythrocyte sedimentation rates (ESR) with time. This site uses cookies. M. abscessus are thus environmentally acquired infections. Spectrum of disease due to rapidly growing mycobacteria. Sputum relapse was defined as two consecutive positive cultures after sputum conversion (18). One patient, whose sputum cultures had converted to negative for 18 months, refused further therapy at 19 months. 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 ]. Identificación rápida de . Viral infections, such as measles, can have severe sequela… For human immunodeficiency virus abscessus organisms positive for human immunodeficiency virus rápido contaminante del. Treatment, the median duration of antibiotic therapy and occasionally surgical management and Critical Care Medicine causar mycobacterium abscessus in lungs crónica,... 29 ) performed with standard Methods ( 13 ), the median of! Been identified that can cause lung infections are caused by NTM, most commonly M. avium, M was. 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