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Published on: April 25, 2014
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Optimizing macrolide resistance detection for Mycobacterium abscessus: a potential low-cost, time-saving alternative.
Liang-En Hwang1, Aristine Cheng1, Hsin-Yun Sun1
1Department of Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Microbiology Spectrum
|September 8, 2025
Summary
Predicting inducible macrolide resistance in Mycobacterium abscessus complex infections may be possible within one week. This early drug susceptibility testing method shows promise for guiding treatment of difficult-to-treat MABC infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- The Mycobacterium abscessus complex (MABC) presents significant treatment challenges.
- Current guidelines for MABC macrolide resistance detection involve lengthy incubation periods or genetic sequencing.
- Early and accurate detection of inducible macrolide resistance is crucial for effective MABC treatment.
Purpose of the Study:
- To evaluate the potential of monitoring the evolution of minimum inhibitory concentrations (MICs) to predict inducible macrolide resistance in MABC.
- To correlate early resistance prediction with clinical outcomes in extrapulmonary MABC infections.
- To assess a potentially faster and more cost-effective alternative to current resistance detection methods.
Main Methods:
- Retrospective analysis of 35 MABC isolates from extrapulmonary sites (2013-2015).
- Drug susceptibility testing (DST) with MICs read at D3, D7, and D14.
- Proposed prediction rule: a fourfold or greater increase in clarithromycin MIC between D3 and D7.
- Comparison of proposed rule with genotypic prediction (erm41 and rrl sequencing).
- Review of clinical data and treatment outcomes for patients.
Main Results:
- The study identified 16 subsp. abscessus, 18 subsp. massiliense, and 1 subsp. bolletii isolates, with an overall inducible macrolide resistance rate of 40%.
- The proposed early DST prediction rule demonstrated 81% sensitivity and 100% specificity.
- Genotypic prediction showed 75% sensitivity and 100% specificity.
- Of 18 patients with evaluable outcomes, 77.8% experienced favorable outcomes, with most receiving macrolide-based treatment and surgery.
Conclusions:
- Early DST read within one week shows promising potential for accurately detecting inducible macrolide resistance in MABC.
- This method may offer a faster, potentially lower-cost alternative to current diagnostic approaches.
- Further validation in larger cohorts, including pulmonary MABC disease, is warranted for broader clinical application.
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