Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine.
Clin Infect Dis. 2017 Feb 1;64(3):309-316. doi: 10.1093/cid/ciw724. Epub 2016 Nov 10.
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.
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.
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.
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.
NCT00970801.
分枝杆菌脓肿亚种脓肿肺病患者的治疗结果较差，与治疗结果相关的微生物特征尚未得到系统研究。本研究的目的是确定分枝杆菌脓肿肺病患者的微生物特征与治疗结果之间的关联。
纳入 2002 年 1 月至 2012 年 12 月期间接受抗生素治疗≥12 个月的 67 例分枝杆菌脓肿肺病患者。对 44 例患者的分离株进行形态学和遗传学分析。
最终 34 例（51%）患者的痰培养转为阴性。与 24 例持续阳性培养患者的分离株相比，20 例最终转为阴性的患者的预处理分离株更可能表现为光滑菌落（9/20，45%比 2/24，8%；P=0.020）、对克拉霉素的敏感性（7/20，35%比 1/24，4%；P=0.015），并且 erm(41)基因的 C28 序列（6/20，30%比 1/24，4%；P=0.035）。5 例（15%）患者在成功完成抗生素治疗后出现分枝杆菌脓肿肺病复发。基因分析显示，抗生素治疗期间持续阳性培养的大多数发作（22/24，92%）和治疗完成后所有微生物学复发病例均由患者体内不同的分枝杆菌脓肿基因型引起。
精确鉴定亚种水平并分析分枝杆菌特征有助于预测分枝杆菌脓肿肺病患者的治疗结果。治疗失败和复发常与多种基因型相关，提示再感染。
NCT00970801。
