Clinical Significance of Differentiation of Mycobacterium massiliense from Mycobacterium abscessus
Clinical Significance of Differentiation of Mycobacterium massiliense from Mycobacterium abscessus
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DOI：
10.1164/rccm.201003-0395oc
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发表时间：
2011-02-01
影响因子：
24.7
通讯作者：
Kwon, O. Jung
中科院分区：
文献类型：
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作者：
Koh, Won-Jung;Jeon, Kyeongman;Kwon, O. Jung
理由：马西分枝杆菌已被认为是与脓肿分枝杆菌不同的一个物种；然而，关于这种分化的临床影响知之甚少。 目的：比较脓肿分枝杆菌肺病和马西里分枝杆菌肺病患者的临床特征和治疗结果。方法：我们对储存的脓肿分枝杆菌复合体临床分离株进行分子鉴定，并比较 64 名脓肿分枝杆菌肺病患者和 81 名马西里分枝杆菌肺病患者的临床特征和治疗结果。测量和主要结果：每个物种引起的疾病的临床和放射学表现是相似的。 57 名患者（24 名脓肿分枝杆菌，33 名马西分枝杆菌）接受了标准化联合抗生素治疗超过 12 个月，其中包括含克拉霉素的治疗方案与最初 4 周疗程的头孢西丁和阿米卡星相结合。马西里分枝杆菌感染患者的痰液转化和维持阴性痰培养的患者比例（88%）高于脓肿分枝杆菌感染患者（25%；P < 0.001）。在所有测试的脓肿分枝杆菌分离株 (n = 19) 中均发现了对克拉霉素的诱导耐药性（最低抑菌浓度 a >= 32 mu g/ml），但在马西分枝杆菌分离株 (n = 28) 中均未发现。 结论：马西分枝杆菌肺病患者对包括克拉霉素在内的联合抗生素治疗的治疗反应率远高于脓肿分枝杆菌肺病患者。对克拉霉素的诱导耐药性可以解释含克拉霉素的抗生素疗法对脓肿分枝杆菌肺部疾病缺乏疗效的原因。
Rationale: Mycobacterium massiliense has been recognized as a separate species from Mycobacterium abscessus; however, little is known regarding the clinical impact of this differentiation.Objectives: To compare clinical features and treatment outcomes between patients with M. abscessus lung disease and those with M. massiliense lung disease.Methods: We performed molecular identification of stored clinical isolates of M. abscessus complex and compared clinical characteristics and treatment outcomes between 64 patients with M. abscessus lung disease and 81 patients with M. massiliense lung disease.Measurements and Main Results: The clinical and radiographic manifestations of disease caused by each species were similar. Standardized combination antibiotic therapy, including a clarithromycin-containing regimen in combination with an initial 4-week course of cefoxitin and amikacin, was given to 57 patients (24 with M. abscessus and 33 with M. massiliense) for more than 12 months. The proportion of patients with sputum conversion and maintenance of negative sputum cultures was higher in patients with M. massiliense infection (88%) than in those with M. abscessus infection (25%; P < 0.001). Inducible resistance to clarithromycin (minimal inhibitory concentrations a >= 32 mu g/ml) was found in all tested M. abscessus isolates (n = 19), but in none of the M. massiliense isolates (n = 28).Conclusions: Treatment response rates to combination antibiotic therapy including clarithromycin were much higher in patients with M. massiliense lung disease than in those with M. abscessus lung disease. The inducible resistance to clarithromycin could explain the lack of efficacy of clarithromycin-containing antibiotic therapy against M. abscessus lung disease.