Mycobacterial characteristics and treatment outcomes in mycobacterium abscessus lung disease

Won Jung Koh, Byeong Ho Jeong, Su Young Kim, Kyeongman Jeon, Kyoung Un Park, Byung Woo Jhun, Hyun Lee, Hye Yun Park, Dae Hun Kim, Hee Jae Huh, Chang Seok Ki, Nam Yong Lee, Hong Kwan Kim, Yong Soo Choi, Jhingook Kim, Seung Heon Lee, Chang Ki Kim, Sung Jae Shin, Charles L. Daley, Hojoong KimO. Jung Kwon

    Research output: Contribution to journalArticlepeer-review

    109 Citations (Scopus)

    Abstract

    Background. Treatment outcomes of patients with Mycobacterium abscessus subspecies abscessus lung disease are poor, and the microbial characteristics associated with treatment outcomes have not been studied systematically. The purpose of this study was to identify associations between microbial characteristics and treatment outcomes in patients with M. abscessus lung disease. Methods. Sixty-seven consecutive patients with M. abscessus lung disease undergoing antibiotic treatment for ≥12 months between January 2002 and December 2012 were included. Morphotypic and genetic analyses were performed on isolates from 44 patients. Results. Final sputum conversion to culture negative occurred in 34 (51%) patients. Compared to isolates from 24 patients with persistently positive cultures, pretreatment isolates from 20 patients with final negative conversion were more likely to exhibit smooth colonies (9/20, 45% vs 2/24, 8%; P = .020), susceptibility to clarithromycin (7/20, 35% vs 1/24, 4%; P = .015), and be of the C28 sequevar with regard to the erm(41) gene (6/20, 30% vs 1/24, 4%; P = .035). Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. Genotypic analysis revealed that most episodes (22/24, 92%) of persistently positive cultures during antibiotic treatment and all cases of microbiologic recurrence after treatment completion were caused by different M. abscessus genotypes within a patient. Conclusions. Precise identification to the subspecies level and analysis of mycobacterial characteristics could help predict treatment outcomes in patients with M. abscessus lung disease. Treatment failures and recurrences are frequently associated with multiple genotypes, suggesting reinfection. Clinical Trials Registration. NCT00970801.

    Original languageEnglish
    Pages (from-to)309-316
    Number of pages8
    JournalClinical Infectious Diseases
    Volume64
    Issue number3
    DOIs
    Publication statusPublished - 2017 Feb 1

    Keywords

    • Lung disease
    • Macrolides
    • Mycobacterium abscessus
    • Nontuberculous mycobacteria

    ASJC Scopus subject areas

    • Microbiology (medical)
    • Infectious Diseases

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