Jeong Suk Hyeon, Kim Su-Young, Huh Hee Jae, Ki Chang-Seok, Lee Nam Yong, Kang Cheol-In, Chung Doo Ryeon, Peck Kyong Ran, Shin Sung Jae, Koh Won-Jung
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Int J Infect Dis. 2017 Jul;60:49-56. doi: 10.1016/j.ijid.2017.05.007. Epub 2017 May 15.
The differentiation between Mycobacterium abscessus subspecies abscessus (M. abscessus) and Mycobacterium abscessus subspecies massiliense (M. massiliense) and determination of the presence of inducible resistance to macrolide antibiotics are important factors in the management of patients with Mycobacterium abscessus complex (MABC) infections. Unlike pulmonary MABC infections, little information on extrapulmonary MABC infections is available.
The molecular identification of clinical isolates was performed, and the clinical characteristics and treatment outcomes of 20 consecutive patients with extrapulmonary MABC infections were assessed.
M. abscessus and M. massiliense each caused 10 (50%) of the cases. Eight (80%) M. abscessus isolates that had inducible resistance to clarithromycin harbored an intact erm(41) gene of the T28 variant, whereas two (20%) M. abscessus isolates had the C28 erm(41) variant and were susceptible to clarithromycin. All M. massiliense isolates had a truncated erm(41) gene and were susceptible to clarithromycin. The drug susceptibility profiles other than clarithromycin were similar for the M. abscessus and M. massiliense isolates. Of the 20 patients, 17 (85%) showed a favorable outcome, including all patients with M. massiliense infection and 70% (7/10) of patients with M. abscessus infection. Favorable outcomes were associated with M. massiliense and M. abscessus isolates with a non-functional erm(41) gene (p=0.049).
Precise species and subspecies identification and the determination of macrolide susceptibility are recommended for the optimal treatment of extrapulmonary MABC infections.
区分脓肿分枝杆菌脓肿亚种（M. abscessus）和脓肿分枝杆菌马西利亚亚种（M. massiliense），并确定对大环内酯类抗生素的诱导耐药性，是脓肿分枝杆菌复合群（MABC）感染患者管理中的重要因素。与肺部MABC感染不同，关于肺外MABC感染的信息很少。
对临床分离株进行分子鉴定，并评估20例连续肺外MABC感染患者的临床特征和治疗结果。
M. abscessus和M. massiliense各导致10例（50%）病例。8株（80%）对克拉霉素有诱导耐药性的M. abscessus分离株携带完整的T28变体erm(41)基因，而2株（20%）M. abscessus分离株具有C28 erm(41)变体，对克拉霉素敏感。所有M. massiliense分离株均有截短的erm(41)基因，对克拉霉素敏感。M. abscessus和M. massiliense分离株除克拉霉素外的药敏谱相似。20例患者中，17例（85%）预后良好，包括所有M. massiliense感染患者和70%（7/10）的M. abscessus感染患者。预后良好与erm(41)基因无功能的M. massiliense和M. abscessus分离株相关（p = 0.049）。
对于肺外MABC感染的最佳治疗，建议进行精确的菌种和亚种鉴定以及大环内酯类药敏测定。
