1887

Abstract

Structural lung diseases or scarring related to prior infections such as tuberculosis (TB) are risk factors for the development of invasive nontuberculous mycobacterial (NTM) pulmonary infections, such as Mycobacterium abscessus . M. abscessus is intrinsically resistant to many antibiotics and in vitro susceptibility correlates poorly with clinical response, especially in pulmonary disease. Treatment is often difficult due to the lack of effective antibiotic regimens. We present a case of a 56-year-old male previously treated for TB, with presumed exacerbation, who was diagnosed after much delay with pulmonary M. abscessus disease and subsequently failed initial treatment with an empirical antibiotic regimen. When placed on a synergistic combination regimen that included amikacin, linezolid, clarithromycin, ethambutol and faropenem, the patient showed a favourable response and was culture-negative for over 12 months when the treatment was stopped as per American Thoracic Society (ATS) recommendations. Unfortunately, he developed recurrent symptoms and died 9 months after stopping treatment, following an acute exacerbation of fever and respiratory failure.

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2019-03-20
2019-12-07
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References

  1. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007;175:367–416 [CrossRef]
    [Google Scholar]
  2. Daley CL, Griffith DE. Pulmonary disease caused by rapidly growing mycobacteria. Clin Chest Med 2002;23:623–632
    [Google Scholar]
  3. Greendyke R, Byrd TF. Differential antibiotic susceptibility of Mycobacterium abscessus variants in biofilms and macrophages compared to that of planktonic bacteria. Antimicrob Agents Chemother 2008;52:2019–2026 [CrossRef]
    [Google Scholar]
  4. Maurer FP, Bruderer VL, Ritter C, Castelberg C, Bloemberg GV et al. Lack of antimicrobial bactericidal activity in Mycobacterium abscessus. Antimicrob Agents Chemother 2014;58:3828–3836 [CrossRef]
    [Google Scholar]
  5. Standards NCfCLSusceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; Approved Standard Wayne, PA: NCCLS; 2003
  6. Cremades R, Santos A, Rodríguez JC, Garcia-Pachón E, Ruiz M et al. Mycobacterium abscessus from respiratory isolates: activities of drug combinations. J Infect Chemother 2009;15:46–48 [CrossRef]
    [Google Scholar]
  7. Oh CT, Moon C, Park OK, Kwon SH, Jang J. Novel drug combination for Mycobacterium abscessus disease therapy identified in a Drosophila infection model. J Antimicrob Chemother 2014;69:1599–1607 [CrossRef]
    [Google Scholar]
  8. Zhang Z, Lu J, Song Y, Pang Y. In vitro activity between linezolid and other antimicrobial agents against Mycobacterium abscessus complex. Diagn Microbiol Infect Dis 2018;90:31–34 [CrossRef]
    [Google Scholar]
  9. Kaushik A, Makkar N, Pandey P, Parrish N, Singh U et al. Carbapenems and rifampin exhibit synergy against Mycobacterium tuberculosis and Mycobacterium abscessus. Antimicrob Agents Chemother 2015;59:6561–6567 [CrossRef]
    [Google Scholar]
  10. Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B. Mycobacterium abscessus: a new antibiotic nightmare. J Antimicrob Chemother 2012;67:810–818 [CrossRef]
    [Google Scholar]
  11. Novosad SA, Beekmann SE, Polgreen PM, Mackey K, Winthrop KL et al. Treatment of Mycobacterium abscessus infection. Emerg Infect Dis 2016;22:511–514 [CrossRef]
    [Google Scholar]
  12. Floto RA, Olivier KN, Saiman L, Daley CL, Herrmann JL et al. US cystic fibrosis foundation and European cystic fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis. Thorax 2016;71:1–22 [CrossRef]
    [Google Scholar]
  13. Jarand J, Levin A, Zhang L, Huitt G, Mitchell JD et al. Clinical and microbiologic outcomes in patients receiving treatment for Mycobacterium abscessus pulmonary disease. Clin Infect Dis 2011;52:565–571 [CrossRef]
    [Google Scholar]
  14. Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother 2009;53:1367–1376 [CrossRef]
    [Google Scholar]
  15. Kaushik A, Gupta C, Fisher S, Story-Roller E, Galanis C et al. Combinations of avibactam and carbapenems exhibit enhanced potencies against drug-resistant Mycobacterium abscessus. Future Microbiol 2017;12:473–480 [CrossRef]
    [Google Scholar]
  16. Story-Roller E, Maggioncalda EC, Cohen KA, Lamichhane G. Mycobacterium abscessus and β-lactams: emerging insights and potential opportunities. Front Microbiol 2018;9:2273 [CrossRef]
    [Google Scholar]
  17. Tanaka E, Kimoto T, Tsuyuguchi K, Suzuki K, Amitani R. Successful treatment with faropenem and clarithromycin of pulmonary Mycobacterium abscessus infection. J Infect Chemother 2002;8:252–255 [CrossRef]
    [Google Scholar]
  18. Woodcock JM, Andrews JM, Brenwald NP, Ashby JP, Wise R. The in-vitro activity of faropenem, a novel oral penem. J Antimicrob Chemother 1997;39:35–43
    [Google Scholar]
  19. Diel R, Ringshausen F, Richter E, Welker L, Schmitz J et al. Microbiological and clinical outcomes of treating non-Mycobacteriumavium complex nontuberculous mycobacterial pulmonary disease: a systematic review and meta-analysis. Chest 2017;152:120–142 [CrossRef]
    [Google Scholar]
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