National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China.
Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China.
Diagn Microbiol Infect Dis. 2024 Oct;110(2):116435. doi: 10.1016/j.diagmicrobio.2024.116435. Epub 2024 Jul 11.
Mycobacterium abscessus complex (MABC) infections are increasing worldwide. Furthermore, these infections have a low treatment success rate due to their resistance to many current antibiotics. This study aimed to determine the overall in vitro activity of the tetracyclines doxycycline (DOX), minocycline (MIN), and tigecycline (TGC) against MABC clinical isolates.
A systematic review of PubMed/MEDLINE, Web of Science, and Embase was conducted up to August 28, 2023. Studies applying the drug susceptibility testing standards of the Clinical and Laboratory Standards Institute were considered. A random effects model was used to assess the total in vitro resistance rates of the MABC clinical isolates to DOX, MIN, and TGC. The I and Cochran's Q statistics were employed to evaluate the origins of heterogeneity. All analyses were conducted using CMA V.3 software.
Twenty-six publications (22, 12, and 11 studies on DOX, MIN, and TGC, respectively) were included. The pooled in vitro resistance rates of the MABC clinical isolates to DOX and MIN at the breakpoint of 8 μg/mL were 93.0 % (95 % CI, 89.2 %-95.5 %) and 87.2 % (95 % CI, 76.5 %-93.4 %), respectively. In the case of TGC, the breakpoints of 2, 4, and 8 μg/mL were associated with pooled resistance rates of 2.5 % (95 % CI, 0.5 %-11.6 %), 7.2 % (95 % CI, 4.0 %-12.5 %), and 16.8 % (95 % CI, 4.7 %-45.0 %), respectively.
Among the three examined tetracyclines, MABC exhibited extremely high resistance rates to DOX and MIN, thereby limiting their use in treating MABC infections. Conversely, MABC showed an increased susceptibility rate to TGC, highlighting TGC administration as a viable treatment option for patients with MABC infections.
脓肿分枝杆菌复合体（MABC）感染在全球范围内呈上升趋势。此外，由于其对许多现有抗生素的耐药性，这些感染的治疗成功率较低。本研究旨在确定四环素类药物多西环素（DOX）、米诺环素（MIN）和替加环素（TGC）对 MABC 临床分离株的总体体外活性。
对 PubMed/MEDLINE、Web of Science 和 Embase 进行了系统回顾，检索截至 2023 年 8 月 28 日的文献。纳入应用临床和实验室标准协会药物敏感性检测标准的研究。采用随机效应模型评估 MABC 临床分离株对 DOX、MIN 和 TGC 的总体外耐药率。采用 I ² 和 Cochran's Q 统计量评估异质性的来源。所有分析均使用 CMA V.3 软件进行。
共纳入 26 篇文献（分别有 22、12 和 11 篇关于 DOX、MIN 和 TGC 的研究）。MABC 临床分离株对 8μg/ml 折点 DOX 和 MIN 的体外耐药率分别为 93.0%（95%CI，89.2%-95.5%）和 87.2%（95%CI，76.5%-93.4%）。对于 TGC，2、4 和 8μg/ml 的折点与总体耐药率分别为 2.5%（95%CI，0.5%-11.6%）、7.2%（95%CI，4.0%-12.5%）和 16.8%（95%CI，4.7%-45.0%）相关。
在所研究的三种四环素类药物中，MABC 对 DOX 和 MIN 表现出极高的耐药率，从而限制了它们在治疗 MABC 感染中的应用。相反，MABC 对 TGC 的敏感性增加，提示 TGC 给药可作为 MABC 感染患者的一种可行治疗选择。
