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 articlepeer-review

    20 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

    Keywords

    • Drug resistance
    • Macrolides
    • Mycobacterium massiliense
    • Nontuberculous mycobacteria

    ASJC Scopus subject areas

    • Pharmacology
    • Pharmacology (medical)
    • Infectious Diseases

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