Abstract
Mycobacterium abscessus disease is particularly challenging to treat, given the intrinsic drug resistance of this species and the limited data on which recommendations are based, resulting in a greater reliance on expert opinion. We address several commonly encountered questions and management considerations regarding pulmonary Mycobacterium abscessus disease, including the role of subspecies identification, diagnostic criteria for determining disease, interpretation of drug susceptibility test results, approach to therapy including the need for parenteral antibiotics and the role for new and repurposed drugs, and the use of adjunctive strategies such as airway clearance and surgical resection.
Highlights
Mycobacterium abscessus complex (M. abscessus) is part of a group of rapidly growing mycobacteria (RGM) that can be found in soil and water and accounts for the majority of pulmonary nontuberculous mycobacteria (NTM) infections due to RGM [1]
Given its increasing prevalence [2] and intrinsic multidrug resistance [3], to complement other review articles on this topic [4,5,6,7], this article will focus on common clinical questions that arise during the management of pulmonary M. abscessus disease
Clinicians reliant on testing from commercial laboratories should be aware that only a few laboratories screen for inducible macrolide resistance, so the authors recommend the use of laboratories with experience in performing mycobacterial drug susceptibility testing (DST)
Summary
Some laboratories still report M. abscessus isolates as part of an M. abscessus/chelonae complex, increasing use of. Top Questions in the Diagnosis and Treatment of Pulmonary ofid 1 molecular methods such as rpoB gene sequencing should be able to distinguish between the 2 organisms and the subspecies that comprise the M. abscessus group: abscessus, massiliense, and bolletii [8, 13]. Bolletii isolates have intrinsic macrolide resistance due to the presence of a functional inducible erythromycin ribosomal methylase (erm) 41 gene [11]. This gene is present but not functional in most M. abscessus subsp. There is growing interest in the use of whole-genome sequencing (WGS) to determine subspecies identification, further optimization of this tool is needed before it is ready for clinical use [15]
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