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

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

Research output: Contribution to journalReview article

8 Citations (Scopus)

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.

Original languageEnglish
Article numbere02189
JournalAntimicrobial agents and chemotherapy
Volume61
Issue number2
DOIs
Publication statusPublished - 2017 Feb

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Macrolides
Mycobacterium
Lung Diseases
Anti-Bacterial Agents
Therapeutics
Mycobacterium avium Complex
Mortality
Medical Genetics
rRNA Genes
Point Mutation
Medical Records
Infection

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Choi, Hayoung ; Kim, Su Young ; Lee, Hyun ; Jhun, Byung Woo ; Park, Hye Yun ; Jeon, Kyeongman ; Kim, Dae Hun ; Huh, Hee Jae ; Ki, Chang Seok ; Lee, Nam Yong ; Lee, Seung Heon ; Shin, Sung Jae ; Daley, Charles L. ; Koh, Won Jung. / Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium massiliense lung disease. In: Antimicrobial agents and chemotherapy. 2017 ; Vol. 61, No. 2.
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title = "Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium massiliense lung disease",
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.",
author = "Hayoung Choi and Kim, {Su Young} and Hyun Lee and Jhun, {Byung Woo} and Park, {Hye Yun} and Kyeongman Jeon and Kim, {Dae Hun} and Huh, {Hee Jae} and Ki, {Chang Seok} and Lee, {Nam Yong} and Lee, {Seung Heon} and Shin, {Sung Jae} and Daley, {Charles L.} and Koh, {Won Jung}",
year = "2017",
month = "2",
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Choi, H, Kim, SY, Lee, H, Jhun, BW, Park, HY, Jeon, K, Kim, DH, Huh, HJ, Ki, CS, Lee, NY, Lee, SH, Shin, SJ, Daley, CL & Koh, WJ 2017, 'Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium massiliense lung disease', Antimicrobial agents and chemotherapy, vol. 61, no. 2, e02189. https://doi.org/10.1128/AAC.02189-16

Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium massiliense lung disease. / Choi, Hayoung; Kim, Su Young; Lee, Hyun; Jhun, Byung Woo; Park, Hye Yun; Jeon, Kyeongman; Kim, Dae Hun; Huh, Hee Jae; Ki, Chang Seok; Lee, Nam Yong; Lee, Seung Heon; Shin, Sung Jae; Daley, Charles L.; Koh, Won Jung.

In: Antimicrobial agents and chemotherapy, Vol. 61, No. 2, e02189, 02.2017.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium massiliense lung disease

AU - Choi, Hayoung

AU - Kim, Su Young

AU - Lee, Hyun

AU - Jhun, Byung Woo

AU - Park, Hye Yun

AU - Jeon, Kyeongman

AU - Kim, Dae Hun

AU - Huh, Hee Jae

AU - Ki, Chang Seok

AU - Lee, Nam Yong

AU - Lee, Seung Heon

AU - Shin, Sung Jae

AU - Daley, Charles L.

AU - Koh, Won Jung

PY - 2017/2

Y1 - 2017/2

N2 - 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.

AB - 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.

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U2 - 10.1128/AAC.02189-16

DO - 10.1128/AAC.02189-16

M3 - Review article

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