Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Int J Infect Dis. 2022 Mar;116:21-26. doi: 10.1016/j.ijid.2021.12.348. Epub 2021 Dec 24.
Precise subspeciation of Mycobacterium abscessus complex (MAB) is crucial for predicting antibiotic susceptibilities and patient outcomes. However, routine clinical microbiology laboratories have limited diagnostic tools for the differentiation of the subspecies. Thus, we investigated the predictors for MAB subspecies to actuate rapid differentiation and the optimal treatment plans.
We retrospectively identified stored clinical isolates of MAB and reviewed patient medical records to compare clinical characteristics, sites of infection, and outcomes among patients infected with M. abscessus subsp. abscessus (M. abscessus) and M. abscessus subsp. massiliense (M. massiliense). MAB subspecies were characterised by multilocus sequence analysis with 3-locus sequence (hsp65, rpoB, and secA1) and pulsed-field gel electrophoresis.
After outbreak and duplicated cases were excluded, 56 and 36 patients with infection caused by M. abscessus and M. massiliense, respectively, were included in the analysis. Patients with either cardiovascular disease or risk factors for cardiovascular disease (male gender and age ≥55 years) were 4.5 times more likely to harbour M. abscessus (P = 0.002), whereas M. massiliense was 4.8 times more frequently recovered from cutaneous and surgical wounds (P = 0.04).
Distinct host and organ specificity were observed among patients infected with M. abscessus and those with M. massiliense. These differences may provide clinically significant clues to optimise treatment strategies.
准确区分脓肿分枝杆菌复合群（MAB）对于预测抗生素敏感性和患者预后至关重要。然而，常规临床微生物学实验室用于区分亚种的诊断工具有限。因此，我们研究了 MAB 亚种的预测因素，以实现快速区分和最佳治疗方案。
我们回顾性地确定了 MAB 的储存临床分离株，并查阅了患者病历，以比较感染脓肿分枝杆菌亚种脓肿亚种（M. abscessus）和脓肿分枝杆菌亚种马萨诸塞亚种（M. massiliense）的患者的临床特征、感染部位和结局。通过 3 个基因座（hsp65、rpoB 和 secA1）和脉冲场凝胶电泳的多位点序列分析来确定 MAB 亚种特征。
排除暴发和重复病例后，分析了分别由 M. abscessus 和 M. massiliense 感染的 56 例和 36 例患者。患有心血管疾病或心血管疾病风险因素（男性和年龄≥55 岁）的患者更有可能携带 M. abscessus（P=0.002），而 M. massiliense 更常从皮肤和外科伤口中分离出来（P=0.04）。
感染 M. abscessus 和 M. massiliense 的患者之间存在明显的宿主和器官特异性。这些差异可能为优化治疗策略提供有临床意义的线索。
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