Mycobacterium abscessus group pulmonary disease

Mycobacterium abscessus is the second most isolated nontuberculous mycobacterial (NTM) respiratory pathogen in United States. It is also among the most difficult to treat NTM respiratory pathogens. The purpose of this review is to highlight current opportunities and limitations in the management of M. abscessus pulmonary disease and ways to optimize therapy to avoid treatment choices that make management of these patients even more difficult.

The main themes of the manuscript emphasize recognition of M. abscessus drug resistance mechanisms and their implication for limiting M. abscessus treatment response. The dichotomy between favorable outcomes for macrolide-susceptible vs. macrolide-resistant M. abscessus isolates is discussed in detail as well as the limitations in our current in-vitro susceptibility testing of M. abscessus isolates.

Predictably favorable treatment outcomes for patients with M. abscessus pulmonary disease remain elusive. New antibiotic combinations offer promise but await clinical testing in prohibitively expensive trials. Some new approaches such as phage therapy have been introduced, but so far, none are universally available or reliably effective. Clinicians and patients are left to struggle with imperfect treatment strategies in the hopes that some will emerge to justify larger treatment trials.