Clinical emergence of inducible macrolide resistance mediated by acquired erm(41) C28T mutation in Mycobacterium abscessus
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Published on: September 9, 2015
Guiqing He1,2, Shushu Zeng3, Lilla Terezia Banki3
1Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China.
Abstract:
Inducible macrolide resistance mediated by the erm(41) T28 allele is a well-established intrinsic mechanism in Mycobacterium abscessus. Here, we report a case of M. abscessus pulmonary disease in which an initial erm(41) C28 isolate developed inducible resistance through a de novo C28T point mutation during prolonged therapy. To our knowledge, this case provides the first clinical evidence that erm(41)-mediated inducible resistance can arise in vivo under antimicrobial selective pressure.
Insights
Mycobacterium abscessus can develop inducible macrolide resistance during treatment. A point mutation in the erm(41) gene led to resistance in a patient with pulmonary disease, showing in vivo resistance development.
Area of Science:
- Microbiology
- Genetics
- Clinical Medicine
Background:
- Inducible macrolide resistance in Mycobacterium abscessus is often mediated by the erm(41) T28 allele.
- This resistance mechanism is considered an intrinsic trait in M. abscessus.
Purpose of the Study:
- To report a case of M. abscessus pulmonary disease.
- To document the emergence of inducible macrolide resistance in vivo.
- To investigate the genetic basis of acquired resistance during therapy.
Main Methods:
- Case report of a patient with M. abscessus pulmonary disease.
- Genomic analysis of M. abscessus isolates.
- Antimicrobial susceptibility testing.
Main Results:
- The initial M. abscessus isolate carried the erm(41) C28 allele.
- During prolonged therapy, a de novo C28T point mutation was identified in the erm(41) gene.
- The isolate developed inducible macrolide resistance.
Conclusions:
- This case provides the first clinical evidence of inducible erm(41)-mediated resistance arising in vivo.
- Antimicrobial selective pressure can drive the development of inducible macrolide resistance in M. abscessus.
- Understanding this mechanism is crucial for managing M. abscessus infections.
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