Mycobacterium abscessus: a new antibiotic nightmare.

Area of Science:

• Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Mycobacterium abscessus infections present therapeutic challenges due to inherent and acquired antibiotic resistance.
• Resistance mechanisms include cell envelope barriers, efflux pumps, altered drug targets, and antibiotic-inactivating enzymes.
• Acquired resistance is documented for aminoglycosides and macrolides via target gene mutations (rrs, rrl).

Purpose of the Study:

• To review and synthesize current knowledge on Mycobacterium abscessus antibiotic resistance.
• To contextualize M. abscessus resistance within findings from other mycobacteria.
• To emphasize the importance of classifying M. abscessus strains (sensu stricto, M. massiliense, M. bolletii) in resistance studies.

Main Methods:

• Literature review of previous and recent findings on M. abscessus antibiotic resistance.
• Comparative analysis of resistance mechanisms across different mycobacterial species.
• Integration of new strain classifications into the understanding of antibiotic susceptibility.

Main Results:

• Intrinsic resistance is multifactorial, involving cell envelope, efflux, target affinity, and enzymatic inactivation.
• Acquired resistance primarily affects aminoglycosides and macrolides through specific gene mutations.
• The three distinct groups within M. abscessus require tailored approaches to antibiotic resistance assessment.

Conclusions:

• Mycobacterium abscessus possesses extensive chemotherapeutic resistance, necessitating further research into underlying molecular events.
• Accurate strain classification is essential for reliable antibiotic susceptibility testing and treatment strategies.
• Continued investigation is vital to overcome the therapeutic limitations imposed by M. abscessus resistance.