Mycobacterium abscessus subsp abscessus lung disease: 'trouble ahead, trouble behind…'

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Mycobacterium abscessus subsp abscessus is a leading cause of respiratory infections among rapidly growing non-tuberculous mycobacteria (NTM).
• This pathogen is notorious for its resistance to antibiotic treatments, posing significant clinical challenges.
• Key resistance mechanisms include inducible erythromycin methylase (erm) genes, leading to acquired macrolide resistance.

Purpose of the Study:

• To highlight the clinical significance of Mycobacterium abscessus subsp abscessus as a respiratory pathogen.
• To emphasize the importance of accurate subspecies identification for guiding treatment decisions.
• To underscore the urgent need for novel antimicrobial agents and effective therapeutic strategies.

Main Methods:

• Review of existing literature on Mycobacterium abscessus subsp abscessus.
• Discussion of antibiotic resistance mechanisms, particularly the erm gene.
• Analysis of the clinical and taxonomic distinctions between M. abscessus subspecies.

Main Results:

• M. abscessus subsp abscessus exhibits innate and inducible antibiotic resistance, notably to macrolides.
• Subspecies identification is critical, as M. abscessus subsp massiliense lacks the erm gene and remains macrolide susceptible.
• Current treatment regimens for M. abscessus subsp abscessus are often ineffective, necessitating new approaches.

Conclusions:

• Accurate and rapid identification of M. abscessus subspecies by laboratories is imperative for effective patient management.
• The development of new antimicrobial drugs is essential to combat infections caused by resistant M. abscessus subsp abscessus.
• M. abscessus subsp abscessus remains a challenging pathogen with limited successful therapeutic outcomes.