Mycobacterium abscessus

The systematic classification of M. abscessus has been changed several times in recent years, based on genetic data. M. abscessus is one of the most frequently isolated mycobacterial species in patients with cystic fibrosis (CF) (Aitken ML et al. 2012). Therefore, there is an increased risk of infection with M. abscessus after lung transplantation. M. abscessus can also cause pulmonary infections, as well as (less commonly) skin lesions, in patients without cystic fibrosis (Griffith DE et al. 2007).

Therapy of diseases caused by M. abscessus is difficult. Combination therapy of oral clarithromycin and parenteral administration of amikacin plus cefoxitin or imipenem for 2 - 4 months followed by 6 - 12 months of oral therapy with drugs tested as sensitive promises improvement but often not definitive cure ((Griffith DE et al. 2007). Among macrolides, azithromycin may have better efficacy than clarithromycin (Choi GE et al.2012;Huang YC et al. 2010). Moxifloxacin is also effective, but in combination with macrolides, an antagonistic effect was observed. A study in Taiwan found the following sensitivities in vitro among 40 isolates for: Amikacin (95.0%), Cefoxitin (32.5%), Ciprofloxacin (10.0%), Clarithromycin (92.5%), Doxycycline (7.5%), Imipenem (12.5%), Moxifloxacin (22.5%), Sulfamethoxazole (7.5%) and Tigecycline (100%) (Huang YC et al. 2010). Because drug therapy alone is often insufficient, an additional surgical approach may be appropriate. In pulmonary infections, the duration of therapy after the first negative culture is an additional 12 months .

1. Griffith DE et al (2007) Am J Respir Crit Care Med 175: 367-416.
2. Aitken ML et al (2012) Respiratory outbreak of Mycobacterium abscessus subspecies massiliense in a lung transplant and cystic fibrosis center. Am J Respir Crit Care Med 185: 231-232.
3. Choi GE et al.(2012) Macrolide treatment for Mycobacterium abscessus and Mycobacterium massiliense infection and inducible resistance. Am J Respir Crit Care Med 186: 917-925.
4. Gonzalez-Santiago TM et al (2015) Nontuberculous Mycobacteria: Skin and Soft Tissue Infections. Dermatol Clin 33:563-77.
5. Huang YC et al (2010) Clinical outcome of Mycobacterium abscessus infection and antimicrobial susceptibility testing. J Microbiol Immunol Infect 43: 401-406.