Clinical characteristics and treatment outcomes of patients with acquired macrolide-resistant Mycobacterium abscessus lung disease

Hayoung Choi, Su Young Kim, Dae Hun Kim, Hee Jae Huh, Chang Seok Ki, Nam Yong Lee, Seung Heon Lee, Soyoun Shin, SungJae Shin, Charles L. Daley, Won Jung Koh

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11 Citations (Scopus)

Abstract

Macrolide antibiotics are mainstays in the treatment of lung disease due to the Mycobacterium abscessus complex. Although previous studies have reported development of acquired macrolide resistance in this species, limited data are available on the outcomes of lung disease due to macrolide-resistant Mycobacterium abscessus subsp. abscessus. This study evaluated the clinical features, treatment outcomes, and molecular characteristics of macrolide-resistant isolates of M. abscessus subsp. abscessus. We performed a retrospective review of medical records and genetic analysis of clinical isolates from 13 patients who had acquired macrolide-resistant M. abscessus subsp. abscessus lung disease between November 2006 and March 2016. Eleven (85%) patients had the nodular bronchiectatic form of the disease, and two (15%) patients had the fibrocavitary form. When acquired macrolide resistance was detected, 10 (77%) patients were on antibiotic therapy for M. abscessus subsp. abscessus, and three (23%) patients were on therapy for lung disease due to other nontuberculous mycobacteria. The median treatment duration after detecting resistance was 24.0 months (interquartile range, 16.0 to 43.0 months). Treatment outcomes were poor, and final sputum culture conversion was achieved in only one (8%) patient, after resectional surgery. All 13 clinical isolates demonstrated point mutations at position 2058 (n 10) or 2059 (n 3) of the 23S rRNA gene, which resulted in acquired macrolide resistance. This study indicates that treatment outcomes are very poor after the development of acquired macrolide resistance in patients with M. abscessus subsp. abscessus lung disease. Thus, more effective measures are needed to prevent development and effectively treat macrolide-resistant M. abscessus subsp. abscessus lung disease.

Original languageEnglish
JournalAntimicrobial agents and chemotherapy
Volume61
Issue number10
DOIs
Publication statusPublished - 2017 Jan 1

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Macrolides
Mycobacterium
Lung Diseases
Anti-Bacterial Agents
Nontuberculous Mycobacteria
Medical Genetics
Therapeutics
Sputum
rRNA Genes
Point Mutation
Medical Records

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Choi, Hayoung ; Kim, Su Young ; Kim, Dae Hun ; Huh, Hee Jae ; Ki, Chang Seok ; Lee, Nam Yong ; Lee, Seung Heon ; Shin, Soyoun ; Shin, SungJae ; Daley, Charles L. ; Koh, Won Jung. / Clinical characteristics and treatment outcomes of patients with acquired macrolide-resistant Mycobacterium abscessus lung disease. In: Antimicrobial agents and chemotherapy. 2017 ; Vol. 61, No. 10.
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abstract = "Macrolide antibiotics are mainstays in the treatment of lung disease due to the Mycobacterium abscessus complex. Although previous studies have reported development of acquired macrolide resistance in this species, limited data are available on the outcomes of lung disease due to macrolide-resistant Mycobacterium abscessus subsp. abscessus. This study evaluated the clinical features, treatment outcomes, and molecular characteristics of macrolide-resistant isolates of M. abscessus subsp. abscessus. We performed a retrospective review of medical records and genetic analysis of clinical isolates from 13 patients who had acquired macrolide-resistant M. abscessus subsp. abscessus lung disease between November 2006 and March 2016. Eleven (85{\%}) patients had the nodular bronchiectatic form of the disease, and two (15{\%}) patients had the fibrocavitary form. When acquired macrolide resistance was detected, 10 (77{\%}) patients were on antibiotic therapy for M. abscessus subsp. abscessus, and three (23{\%}) patients were on therapy for lung disease due to other nontuberculous mycobacteria. The median treatment duration after detecting resistance was 24.0 months (interquartile range, 16.0 to 43.0 months). Treatment outcomes were poor, and final sputum culture conversion was achieved in only one (8{\%}) patient, after resectional surgery. All 13 clinical isolates demonstrated point mutations at position 2058 (n 10) or 2059 (n 3) of the 23S rRNA gene, which resulted in acquired macrolide resistance. This study indicates that treatment outcomes are very poor after the development of acquired macrolide resistance in patients with M. abscessus subsp. abscessus lung disease. Thus, more effective measures are needed to prevent development and effectively treat macrolide-resistant M. abscessus subsp. abscessus lung disease.",
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Clinical characteristics and treatment outcomes of patients with acquired macrolide-resistant Mycobacterium abscessus lung disease. / Choi, Hayoung; Kim, Su Young; Kim, Dae Hun; Huh, Hee Jae; Ki, Chang Seok; Lee, Nam Yong; Lee, Seung Heon; Shin, Soyoun; Shin, SungJae; Daley, Charles L.; Koh, Won Jung.

In: Antimicrobial agents and chemotherapy, Vol. 61, No. 10, 01.01.2017.

Research output: Contribution to journalArticle

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AU - Kim, Su Young

AU - Kim, Dae Hun

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AU - Ki, Chang Seok

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AU - Koh, Won Jung

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AB - Macrolide antibiotics are mainstays in the treatment of lung disease due to the Mycobacterium abscessus complex. Although previous studies have reported development of acquired macrolide resistance in this species, limited data are available on the outcomes of lung disease due to macrolide-resistant Mycobacterium abscessus subsp. abscessus. This study evaluated the clinical features, treatment outcomes, and molecular characteristics of macrolide-resistant isolates of M. abscessus subsp. abscessus. We performed a retrospective review of medical records and genetic analysis of clinical isolates from 13 patients who had acquired macrolide-resistant M. abscessus subsp. abscessus lung disease between November 2006 and March 2016. Eleven (85%) patients had the nodular bronchiectatic form of the disease, and two (15%) patients had the fibrocavitary form. When acquired macrolide resistance was detected, 10 (77%) patients were on antibiotic therapy for M. abscessus subsp. abscessus, and three (23%) patients were on therapy for lung disease due to other nontuberculous mycobacteria. The median treatment duration after detecting resistance was 24.0 months (interquartile range, 16.0 to 43.0 months). Treatment outcomes were poor, and final sputum culture conversion was achieved in only one (8%) patient, after resectional surgery. All 13 clinical isolates demonstrated point mutations at position 2058 (n 10) or 2059 (n 3) of the 23S rRNA gene, which resulted in acquired macrolide resistance. This study indicates that treatment outcomes are very poor after the development of acquired macrolide resistance in patients with M. abscessus subsp. abscessus lung disease. Thus, more effective measures are needed to prevent development and effectively treat macrolide-resistant M. abscessus subsp. abscessus lung disease.

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