Nguyen Victoria L, Eick Kelly L, Gan Mingyu, Miner Taryn A, Friedland Anne E, Carey Allison F, Olivier Kenneth N, Liu Qingyun
Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
JAC Antimicrob Resist. 2025 Apr 2;7(2):dlaf047. doi: 10.1093/jacamr/dlaf047. eCollection 2025 Apr.
(MAB) is a rapidly growing, non-tuberculous mycobacterium that has emerged as a significant pathogen in both pulmonary and extrapulmonary infections. It is rising in prevalence, especially among individuals with underlying lung conditions such as cystic fibrosis and chronic obstructive pulmonary disease, highlighting its growing clinical importance. The treatment of MAB infections is notoriously challenging due to intrinsic resistance to many antibiotics and low cure rates, typically <50%. Macrolides are a cornerstone in the treatment of MAB infections because regimens that include effective macrolide therapy are associated with higher cure rates. However, MAB possesses intrinsic and acquired drug resistance mechanisms against macrolides, complicating drug susceptibility testing and selection of highly effective treatment regimens. This review aims to provide a summary of the current understanding of macrolide resistance mechanisms in MAB. We explored the epidemiology of resistance in different countries and the molecular mechanisms involved. We have highlighted the variability in sensitivity of existing markers to predict phenotypic macrolide drug resistance across different countries, suggesting the involvement of unknown resistance mechanisms. By synthesizing current knowledge and identifying gaps in the literature, this review seeks to inform clinical practice and guide future research efforts in the fight against MAB drug resistance.
鸟分枝杆菌（MAB）是一种快速生长的非结核分枝杆菌，已成为肺部和肺外感染中的重要病原体。其患病率正在上升，尤其是在患有潜在肺部疾病（如囊性纤维化和慢性阻塞性肺疾病）的个体中，这凸显了其日益增长的临床重要性。由于对许多抗生素具有固有耐药性且治愈率低（通常<50%），MAB感染的治疗极具挑战性。大环内酯类药物是治疗MAB感染的基石，因为包含有效大环内酯类治疗的方案与更高的治愈率相关。然而，MAB对大环内酯类药物具有固有和获得性耐药机制，这使得药物敏感性测试和高效治疗方案的选择变得复杂。本综述旨在总结目前对MAB中大环内酯类耐药机制的认识。我们探讨了不同国家的耐药流行病学以及所涉及的分子机制。我们强调了现有标志物在预测不同国家表型大环内酯类药物耐药性方面的敏感性差异，这表明存在未知的耐药机制。通过综合现有知识并找出文献中的空白，本综述旨在为临床实践提供信息，并指导未来对抗MAB耐药性的研究工作。
