Outcomes of Intermittent Multidrug IV Therapy for Refractory Mycobacterium abscessus Pulmonary Disease

Abstract

No studies have reported therapies for the treatment of patients with refractory Mycobacterium abscessus pulmonary disease (MAB-PD). We implemented intermittent multidrug IV therapy (IMIT) through repeated hospitalizations for patients with MAB-PD who were refractory to antibiotics for more than 12months. What are the effects of IMIT on patients with refractory MAB-PD? The IV antibiotics administered for IMIT included amikacin, imipenem, and tigecycline, and the outcomes for 36 patients who underwent IMIT for refractory MAB-PD were evaluated. Patients were repeatedly hospitalized and administered IMIT on recurrent symptoms or radiographic evidence of deterioration, while maintaining oral/inhaled antibiotics. Of the 36 patients, 26 (72%) had Mabscessus subspecies abscessus (herein, Mabscessus)-PD, and 10 (28%) had Mabscessus subspecies massiliense (herein, Mmassiliense)-PD. The median number of hospitalizations for IMIT was two (interquartile range, 1-3) for patients with Mabscessus-PD and one (interquartile range, 1-2) for patients with Mmassiliense-PD. At least one negative culture result and culture conversion were observed in 62%and 12%of patients with Mabscessus-PD, and in 80%and 60%of patients with Mmassiliense-PD, respectively. Symptomatic improvement was observed in all patients, and radiologic improvement, including cavity amelioration or no deterioration, was observed in 42%and 70%of patients with Mabscessus-PD and with Mmassiliense-PD, respectively. No resistance to clarithromycin or amikacin was acquired. IMIT with intermittent hospitalization can be a beneficial palliative treatment for patients with refractory MAB-PD. This therapy alleviated symptoms, slowed radiologic progression, and reduced the bacterial burden in some patients. However, radiologic and microbiological responses to IMIT were more apparent in Mmassiliense-PD than in Mabscessus-PD.