Clinical Efficacy and Adverse Effects of Antibiotics Used to Treat Mycobacterium abscessus Pulmonary Disease.

Jianhui Chen,Zhemin Zhang,Meiping Ye,Liyun Xu,Haiqing Chu,Bing Li,Qi Guo,Lan Zhao,Yongjie Zhang,Yanhua Mao

doi:10.3389/fmicb.2019.01977

Jianhui Chen, Zhemin Zhang + Show 8 more

Open Access

https://doi.org/10.3389/fmicb.2019.01977

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Abstract

Treatment of Mycobacterium abscessus pulmonary infection requires long-term administration of multiple antibiotics. Little is known, however, about the impact of each antibiotic on treatment outcomes. A retrospective analysis was conducted to evaluate the efficacy and adverse effects of antibiotics administered in 244 cases of M. abscessus pulmonary disease. Only 110 (45.1%) patients met the criteria for treatment success. The efficacy of treating M. abscessus pulmonary disease continues to be unsatisfactory especially for infections involving M. abscessus subsp. abscessus. Treatment with drug combinations that included amikacin [adjusted odds ratio (AOR), 3.275; 95% confidence interval (CI), 1.221–8.788], imipenem (AOR, 2.078; 95% CI, 1.151–3.753), linezolid (AOR, 2.231; 95% CI, 1.078–4.616), or tigecycline (AOR, 2.040; 95% CI, 1.079–3.857) was successful. Adverse side effects affected the majority of patients (192/244, 78.7%). Severe effects that resulted in treatment modification included: gastrointestinal distress (29/60, 48.3%) mostly caused by tigecycline, ototoxicity (14/60, 23.3%) caused by amikacin; and myelosuppression (6/60, 10%) caused mainly by linezolid. In conclusion, the success rate of treatment of M. abscessus pulmonary disease is still unsatisfactory. The administration of amikacin, imipenem, linezolid, and tigecycline correlated with increased treatment success. Adverse side effects are common due to long-term, combination antibiotic therapy. Ototoxicity, gastrointestinal distress, and myelosuppression are the most severe.

Highlights

The incidence of pulmonary infections caused by non-tuberculous mycobacteria (NTM) has increased dramatically worldwide in recent years (Hoefsloot et al, 2013; Lin et al, 2018; Lee et al, 2019)
We previously reported a series of studies demonstrating the antibiotic susceptibility of clinical M. abscessus isolates and the treatment outcomes of patients diagnosed with M. abscessus pulmonary disease (Li B. et al, 2017, 2018; Guo et al, 2018; Ye et al, 2019)
75.8% of the patients were infected with M. abscessus subsp. abscessus; 24.2% were infected with M. abscessus subsp. massiliense (Table 1)

Summary

Introduction

The incidence of pulmonary infections caused by non-tuberculous mycobacteria (NTM) has increased dramatically worldwide in recent years (Hoefsloot et al, 2013; Lin et al, 2018; Lee et al, 2019). M. abscessus infections, which are even refractory to combined, long-term antibiotic therapy, often result in mortality. In 2007, the American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) introduced a clarithromycin-based multidrug therapy with amikacin plus cefoxitin or imipenem administered parenterally (Griffith et al, 2007). In 2017, the British Thoracic Society guidelines recommended a revision in antibiotic therapy that consisted of intravenous amikacin, tigecycline, and imipenem with a macrolide, e.g., clarithromycin, for the initial treatment phase (Haworth et al, 2017). This was followed by a continuation phase composed of nebulized amikacin and a macrolide in combination with additional oral antibiotics. It was further recommended that selection of a specific agent should consider the antibiotic susceptibility of the isolate and the antibiotic tolerance of the patient

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