Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
J Microbiol Immunol Infect. 2010 Oct;43(5):401-6. doi: 10.1016/S1684-1182(10)60063-1.
BACKGROUND/PURPOSE: Mycobacterium abscessus is the most resistant and rapidly growing mycobacterium and causes a wide range of clinical infectious diseases. The relationship between antimicrobial susceptibility and clinical outcome needs to be further evaluated.
Forty M. abscessus isolates were obtained from clinical specimens of 40 patients at the Taichung Veterans General Hospital from January 2006 to December 2008. Antimicrobial susceptibility testing was performed using the broth microdilution method according to the recommendations of the National Committee for Clinical Laboratory Standards. The clinical manifestations and outcomes were reviewed from medical records.
Twenty-two patients were diagnosed with M. abscessus infection. Cough (86.3%), hemoptysis (31.8%) and fever (18.1%) were the most common symptoms. The radiographic findings included reticulonodular opacities (50.0%), consolidation (31.8%) and cavitary lesions (18.1%). The 40 isolates were susceptible to amikacin (95.0%), cefoxitin (32.5%), ciprofloxacin (10.0%), clarithromycin (92.5%), doxycycline (7.5%), imipenem (12.5%), moxifloxacin (22.5%), sulfamethoxazole (7.5%) and tigecycline (100%). The rate of treatment failure was 27.3% at the end of the 12(th) month after the start of treatment, although these patients were treated with a combination of clarithromycin and other antimicrobial agents.
M. abscessus is naturally susceptible to clarithromycin and amikacin, variably susceptible to cefoxitin and imipenem, and resistant to most other antimicrobial drugs. Combination therapy with clarithromycin, amikacin and other active antimicrobial agents may lead to clinical improvement; however, the rate of treatment failure is still high.
背景/目的：脓肿分枝杆菌是最具耐药性和生长最快的分枝杆菌，可引起广泛的临床感染性疾病。需要进一步评估抗菌药物敏感性与临床结局之间的关系。
2006 年 1 月至 2008 年 12 月，从台中荣民总医院 40 例患者的临床标本中获得 40 株脓肿分枝杆菌分离株。根据美国临床实验室标准化委员会的建议，采用肉汤微量稀释法进行抗菌药物敏感性试验。从病历中回顾临床表现和结局。
22 例患者被诊断为脓肿分枝杆菌感染。最常见的症状为咳嗽（86.3%）、咯血（31.8%）和发热（18.1%）。影像学表现包括网状结节状阴影（50.0%）、实变（31.8%）和空洞病变（18.1%）。40 株分离株均对阿米卡星（95.0%）、头孢西丁（32.5%）、环丙沙星（10.0%）、克拉霉素（92.5%）、强力霉素（7.5%）、亚胺培南（12.5%）、莫西沙星（22.5%）、复方磺胺甲噁唑（7.5%）和替加环素（100%）敏感。虽然这些患者接受了克拉霉素和其他抗菌药物的联合治疗，但在治疗开始后第 12 个月结束时，治疗失败率仍为 27.3%。
脓肿分枝杆菌天然对克拉霉素和阿米卡星敏感，对头孢西丁和亚胺培南的敏感性不同，对大多数其他抗菌药物耐药。克拉霉素、阿米卡星和其他有效抗菌药物的联合治疗可能会导致临床改善，但治疗失败率仍很高。
