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Impact of Susceptibility to Injectable Antibiotics on the Treatment Outcomes of Mycobacterium abscessus Pulmonary Disease

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Abstract
Background: Current guidelines recommend a susceptibility-based regimen for Mycobacterium abscessus subspecies abscessus pulmonary disease (MAB-PD), but the evidence is weak. We aimed to investigate the association between treatment outcomes and in vitro drug susceptibility to injectable antibiotics in MAB-PD patients.

Methods: We enrolled MAB-PD patients treated with intravenous amikacin and beta-lactams for ≥4 weeks at 4 referral hospitals in Seoul, South Korea. Culture conversion and microbiological cure at 1 year were evaluated based on susceptibility to injectable antibiotics among patients treated with those antibiotics for ≥2 weeks.

Results: A total of 82 patients were analyzed. The mean age was 58.7 years, and 65.9% were women. Sputum culture conversion and microbiological cure were achieved in 52.4% and 41.5% of patients, respectively. Amikacin was the most common agent to which the M. abscessus subspecies abscessus isolates were susceptible (81.7%); 9.8% and 24.0% of the isolates were resistant to cefoxitin and imipenem, respectively. The clarithromycin-inducible resistance (IR) group (n = 65) had a lower microbiological cure rate than the clarithromycin-susceptible group (35.4% vs 64.7%). The treatment outcomes appeared to be similar regardless of in vitro susceptibility results with regard to intravenous amikacin, cefoxitin, imipenem, and moxifloxacin. In the subgroup analysis of the clarithromycin-IR group, the treatment outcomes did not differ according to antibiotic susceptibility.

Conclusions: We did not find evidence supporting the use of susceptibility-based treatment with intravenous amikacin and beta-lactams in patients with MAB-PD. Further research is required.

Keywords: Mycobacterium abscessus; amikacin; beta-lactams; microbial sensitivity tests; nontuberculous mycobacteria; treatment outcome.
Author(s)
심태선조경욱Byung Woo JhunJae-Joon YimJimyung ParkNakwon KwakYea Eun ParkYoung Ae KangYoungmok Park
Issued Date
2021
Type
Article
Keyword
AcademicSubjectsamikacinbeta-lactamsEditor's choiceMajorMED00290microbial sensitivity testsMycobacterium abscessusnontuberculous mycobacteriatreatment outcome
DOI
10.1093/ofid/ofab215
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7123
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8231371&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Impact%20of%20Susceptibility%20to%20Injectable%20Antibiotics%20on%20the%20Treatment%20Outcomes%20of%20Mycobacterium%20abscessus%20Pulmonary%20Disease&offset=0&pcAvailability=true
Publisher
Open Forum Infectious Diseases
Location
미국
Language
영어
ISSN
2328-8957
Citation Volume
8
Citation Number
6
Citation Start Page
215
Citation End Page
215
Appears in Collections:
Medicine > Medicine
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