1
|
Ruedas-López A, Tato M, Broncano-Lavado A, Esteban J, Ruiz-Serrano MJ, Sánchez-Cueto M, Toro C, Domingo D, Cacho J, Barrado L, López-Roa P. Subspecies Distribution and Antimicrobial Susceptibility Testing of Mycobacterium abscessus Clinical Isolates in Madrid, Spain: a Retrospective Multicenter Study. Microbiol Spectr 2023; 11:e0504122. [PMID: 37212700 PMCID: PMC10269645 DOI: 10.1128/spectrum.05041-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Mycobacterium abscessus (MABS) is the most pathogenic and drug-resistant rapidly growing mycobacteria. However, studies on MABS epidemiology, especially those focusing on subspecies level, are scarce. We aimed to determine MABS subspecies distribution and its correlation with phenotypic and genotypic antibiotic profiles. A retrospective multicenter study of 96 clinical MABS isolates in Madrid between 2016 to 2021 was conducted. Identification at the subspecies level and resistance to macrolides and aminoglycosides were performed by the GenoType NTM-DR assay. The MICs of 11 antimicrobials tested against MABS isolates were determined using the broth microdilution method (RAPMYCOI Sensititer titration plates). Clinical isolates included 50 (52.1%) MABS subsp. abscessus; 33 (34.4%) MABS subsp. massiliense; and 13 (13.5%) MABS subsp. bolletii. The lowest resistance rates corresponded to amikacin (2.1%), linezolid (6.3%), cefoxitin (7.3%), and imipenem (14.6%), and the highest to doxycycline (100.0%), ciprofloxacin (89.6%), moxifloxacin (82.3%), cotrimoxazole (82.3%), tobramycin (81.3%), and clarithromycin (50.0% at day 14 of incubation). Regarding tigecycline, although there are no susceptibility breakpoints, all strains but one showed MICs ≤ 1 μg/mL. Four isolates harbored mutations at positions 2058/9 of the rrl gene, one strain harbored a mutation at position 1408 of the rrl gene, and 18/50 harbored the T28C substitution at erm(41) gene. Agreement of the GenoType results with clarithromycin and amikacin susceptibility testing was 99.0% (95/96). The rate of MABS isolates showed an upward trend during the study period, being M. abscessus subsp. abscessus the most frequently isolated subspecies. Amikacin, cefoxitin, linezolid, and imipenem showed great in vitro activity. The GenoType NTM-DR assay provides a reliable and complementary tool to broth microdilution for drug resistance detection. IMPORTANCE Infections caused by Mycobacterium abscessus (MABS) are increasingly being reported worldwide. Identifying MABS subspecies and assessing their phenotypic resistance profiles are crucial for optimal management and better patient outcomes. M. abscessus subspecies differ in erm(41) gene functionality, which is a critical determinant of macrolide resistance. Additionally, resistance profiles of MABS and the subspecies distribution can vary geographically, highlighting the importance of understanding local epidemiology and resistance patterns. This study provides valuable insights into the epidemiology and resistance patterns of MABS and its subspecies in Madrid. Elevated resistance rates were observed for several recommended antimicrobials, emphasizing the need for cautious drug use. Furthermore, we assessed the GenoType NTM-DR assay, which examines principal mutations in macrolides and aminoglycosides resistance-related genes. We observed a high level of agreement between the GenoType NTM-DR assay and the microdilution method, indicating its usefulness as an initial tool for early initiation of appropriate therapy.
Collapse
Affiliation(s)
- Alba Ruedas-López
- Clinical Microbiology and Parasitology Department, Instituto de Investigación, Hospital Universitario, Madrid, Spain.
| | - Marta Tato
- Clinical Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Broncano-Lavado
- Clinical Microbiology and Parasitology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology and Parasitology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades infecciosas CIBERINFEC, Spain
| | - María Jesús Ruiz-Serrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain
| | - María Sánchez-Cueto
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain
| | - Carlos Toro
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Diego Domingo
- Clinical Microbiology and Parasitology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Juana Cacho
- Clinical Microbiology and Parasitology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Laura Barrado
- Clinical Microbiology and Parasitology Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Paula López-Roa
- Clinical Microbiology and Parasitology Department, Instituto de Investigación, Hospital Universitario, Madrid, Spain.
| |
Collapse
|
2
|
Goh BC, Larsson S, Dam LC, Ling YHS, Chua WLP, Abirami R, Singh S, Ong JLE, Teo JWP, Ho P, Ingham PW, Pethe K, Dedon PC. Rifaximin potentiates clarithromycin against Mycobacterium abscessus in vitro and in zebrafish. JAC Antimicrob Resist 2023; 5:dlad052. [PMID: 37168836 PMCID: PMC10164658 DOI: 10.1093/jacamr/dlad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Background Mycobacterium abscessus is a non-tuberculous mycobacterium (NTM) that causes chronic pulmonary infections. Because of its extensive innate resistance to numerous antibiotics, treatment options are limited, often resulting in poor clinical outcomes. Current treatment regimens usually involve a combination of antibiotics, with clarithromycin being the cornerstone of NTM treatments. Objectives To identify drug candidates that exhibit synergistic activity with clarithromycin against M. abscessus. Methods We performed cell-based phenotypic screening of a compound library against M. abscessus induced to become resistant to clarithromycin. Furthermore, we evaluated the toxicity and efficacy of the top compound in a zebrafish embryo infection model. Results The screen revealed rifaximin as a clarithromycin potentiator. The combination of rifaximin and clarithromycin was synergistic and bactericidal in vitro and potent in the zebrafish model. Conclusions The data indicate that the rifaximin/clarithromycin combination is promising to effectively treat pulmonary NTM infections.
Collapse
Affiliation(s)
- Boon Chong Goh
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology Centre, Singapore, Singapore
| | - Simon Larsson
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Linh Chi Dam
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology Centre, Singapore, Singapore
| | - Yan Han Sharon Ling
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology Centre, Singapore, Singapore
| | - Wei Lin Patrina Chua
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology Centre, Singapore, Singapore
| | - R Abirami
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology Centre, Singapore, Singapore
| | - Samsher Singh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jun Long Ernest Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Peiying Ho
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology Centre, Singapore, Singapore
| | - Philip W Ingham
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency of Science, Technology and Research (A*Star), Singapore, Singapore
| | | | | |
Collapse
|
3
|
Dziedzinska R, Okunkova J, Kralik P, Svobodova J, Mala M, Slana I. Identification of and discrimination between the Mycobacterium abscessus complex and Mycobacterium avium complex directly from sputum using quadruplex real-time PCR. J Med Microbiol 2022; 71. [PMID: 36748608 DOI: 10.1099/jmm.0.001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction. Cystic fibrosis (CF) is a serious disease with multisystemic clinical signs that is easily and frequently complicated by bacterial infection. Recently, the prevalence of nontuberculous mycobacteria as secondary contaminants of CF has increased, with the Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABSC) being the most frequently identified. The MABSC includes subspecies of significant clinical importance, mainly due to their resistance to antibiotics.Gap statement. Sensitive method for early detection and differentiation of MABSC members and MAC complex for use in routine clinical laboratories is lacking. A method based on direct DNA isolation from sputum, using standard equipment in clinical laboratories and allowing uncovering of possible sample inhibition (false negative results) would be required. The availability of such a method would allow accurate and accelerated time detection of MABSC members and their timely and targeted treatment.Aim. To develop a real time multiplex assay for rapid and sensitive identification and discrimination of MABSC members and MAC complex.Methodology. The method of DNA isolation directly from the sputum of patients followed by quadruplex real-time quantitative PCR (qPCR) detection was developed and optimised. The sensitivity and limit of detection (LOD) of the qPCR was determined using human sputum samples artificially spiked with a known amount of M. abscessus subsp. massiliense (MAM).Results. The method can distinguish between MAC and MABSC members and, at the same time, to differentiate between M. abscessus subsp. abscessus/subsp. bolletii (MAAb/MAB) and MAM. The system was verified using 61 culture isolates and sputum samples from CF and non-CF patients showing 29.5 % MAAb/MAB, 14.7 % MAM and 26.2 % MAC. The LOD was determined to be 1 490 MAM cells in the sputum sample with the efficiency of DNA isolation being 95.4 %. Verification of the qPCR results with sequencing showed 100 % homology.Conclusions. The developed quadruplex qPCR assay, which is preceded by DNA extraction directly from patients' sputum without the need for culturing, significantly improves and speeds up the entire process of diagnosing CF patients and is therefore particularly suitable for use in routine laboratories.
Collapse
Affiliation(s)
- Radka Dziedzinska
- Laboratory of Neurobiology and Pathological Physiology, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Brno, Czechia
| | - Jana Okunkova
- Microbiology and Antimicrobial Resistance, Veterinary Research Institute, Brno, Czechia
| | - Petr Kralik
- Laboratory of Neurobiology and Pathological Physiology, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Brno, Czechia
| | | | - Miriam Mala
- Department of Pediatric Infectious Diseases, Centre of Cystic Fibrosis, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Iva Slana
- Department of Animal Origin Food & Gastronomic Sciences, University of Veterinary Sciences Brno, Brno, Czechia
| |
Collapse
|
4
|
Kaewprasert O, Tongsima S, Ong RTH, Faksri K. Optimized analysis parameters of variant calling for whole genome-based phylogeny of Mycobacteroides abscessus. Arch Microbiol 2022; 204:190. [PMID: 35194683 DOI: 10.1007/s00203-022-02792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 02/04/2022] [Indexed: 02/05/2023]
Abstract
Whole-genome sequence (WGS) analysis provides the best resolution for reconstructing bacterial phylogeny. However, the resulting tree could vary according to parameters used in the WGS pipeline, making it difficult to compare results across multiple studies. This study compares effects on phylogenies when applying different parameter stringencies. We used as the study model to optimize parameters strains of Mycobacteroides abscessus serially isolated at various intervals, isolates known to represent persistent infection (PI) cases or re-infection (RI) cases and isolates from different subspecies. Un-optimized parameters with low stringency provided an excessive number of SNPs (823) compared to the optimized setting (3 SNPs) between paired strains isolated 1 day apart from PI cases, discordant tree topology and misclassification of subspecies and of instances of RI. We demonstrated that using high-quality variants provides more accuracy for recognizing serial isolates of the same clone versus different clones and for phylogenetic analysis of M. abscessus. Our approach might be used as a model for analyses requiring phylogenetic reconstruction of other bacteria.
Collapse
Affiliation(s)
- Orawee Kaewprasert
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Sissades Tongsima
- National Biobank of Thailand, National Science and Technology Development Agency, Khlong Luang, Pathum Thani, Thailand
- National Center for Genetics Engineering and Biotechnology, National Science and Technology Development Agency, Khlong Luang, Pathum Thani, Thailand
| | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kiatichai Faksri
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand.
| |
Collapse
|
5
|
Chew KL, Soh P, Octavia S, Teo J. Identification of Mycobacterium abscessus to subspecies level with Bruker MALDI Biotyper. Pathology 2022; 54:795-797. [DOI: 10.1016/j.pathol.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
|
6
|
Chew KL, Octavia S, Jureen R, Ng OT, Marimuthu K, Lin RTP, Teo JWP. Molecular epidemiology and phylogenomic analysis of Mycobacterium abscessus clinical isolates in an Asian population. Microb Genom 2021; 7. [PMID: 34845980 PMCID: PMC8743566 DOI: 10.1099/mgen.0.000708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Mycobacterium abscessus comprises three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. bolletii, and M. abscessus subsp. massiliense. These closely related strains are typically multi-drug-resistant and can cause difficult-to-treat infections. Dominant clusters of isolates with increased pathogenic potential have been demonstrated in pulmonary infections in the global cystic fibrosis (CF) population. An investigation was performed on isolates cultured from an Asian, predominantly non-CF population to explore the phylogenomic relationships within our population and compare it to global M. abscessus isolates. Whole-genome-sequencing was performed on M. abscessus isolates between 2017 and 2019. Bioinformatic analysis was performed to determine multi-locus-sequence-type, to establish the phylogenetic relationships between isolates, and to identify virulence and resistance determinants in these isolates. A total of 210 isolates were included, of which 68.5 % (144/210) were respiratory samples. These isolates consisted of 140 (66.6 %) M. abscessus subsp. massiliense, 67 (31.9 %) M. abscessus subsp. abscessus, and three (1.4 %) M. abscessus subsp. bolletii. Dominant sequence-types in our population were similar to those of global CF isolates, but SNP differences in our population were comparatively wider despite the isolates being from the same geographical region. ESX (ESAT-6 secretory) cluster three appeared to occur most commonly in ST4 and ST6 M. abscessus subsp. massiliense, but other virulence factors did not demonstrate an association with isolate subspecies or sample source. We demonstrate that although similar predominant sequence-types are seen in our patient population, cross-transmission is absent. The risk of patient-to-patient transmission appears to be largely limited to the vulnerable CF population, indicating infection from environmental sources remains more common than human-to-human transmission. Resistance and virulence factors are largely consistent across the subspecies with the exception of clarithromycin susceptibility and ESX-3.
Collapse
Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sophie Octavia
- Environmental Health Institute, National Environment Agency, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raymond Tzer Pin Lin
- Department of Laboratory Medicine, National University Hospital, Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| |
Collapse
|
7
|
Chew KL, Octavia S, Yeoh SF, Teo JWP. In Vitro Synergy Testing of Eravacycline in Combination with Clarithromycin and Rifabutin against Mycobacterium abscessus Complex. Microbiol Spectr 2021; 9:e0004521. [PMID: 34132613 PMCID: PMC8552776 DOI: 10.1128/spectrum.00045-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sophie Octavia
- Environmental Health Institute, National Environment Agency, Singapore
| | - Siang Fei Yeoh
- Department of Pharmacy, National University Hospital, Singapore
| | - Jeanette W. P. Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| |
Collapse
|
8
|
Ng HF, Ngeow YF. A single-gene approach for the subspecies classification of Mycobacteroides abscessus. Pathog Dis 2021; 78:5908380. [PMID: 32945880 DOI: 10.1093/femspd/ftaa055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/12/2020] [Indexed: 11/12/2022] Open
Abstract
The subspecies classification of Mycobacteroides abscessus complex into M. abscessus, M. massiliense and M. bolletii requires the amplification and sequencing of multiple genes. The objective of this study was to evaluate the possibility of subspecies classification using a single PCR target. An in silico study was performed to classify 1613 strains deposited in a public database using 9 genes (partial gene sequences of hsp65, rpoB, sodA, argH, cya, glpK, gnd, and murC, and the full gene sequence of MAB_3542c). We found the housekeeping gene gnd to be able to classify the M. abscessus subspecies with high accuracy (99.94%). A single-gene PCR approach based on gnd would be a suitable replacement for the more expensive, labor-intensive and time-consuming multi-gene PCR analysis currently in use for the subspecies identification of M. abscessus.
Collapse
Affiliation(s)
- Hien Fuh Ng
- Centre for Research on Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sungai Long Campus, 43000 Kajang, Selangor, Malaysia
| | - Yun Fong Ngeow
- Centre for Research on Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sungai Long Campus, 43000 Kajang, Selangor, Malaysia
| |
Collapse
|
9
|
Chew KL, Octavia S, Go J, Ng S, Tang YE, Soh P, Yong J, Jureen R, Lin RTP, Yeoh SF, Teo J. In vitro susceptibility of Mycobacterium abscessus complex and feasibility of standardizing treatment regimens. J Antimicrob Chemother 2021; 76:973-978. [PMID: 33338230 DOI: 10.1093/jac/dkaa520] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the in vitro susceptibility of members of the Mycobacterium abscessus complex to routinely tested antibiotics and to an extended antibiotic panel. METHODS Non-duplicate isolates for which susceptibility testing results were available were included in this study. Retrospective laboratory records were reviewed, including tigecycline susceptibility results, and testing was performed with additional drugs, including vancomycin, dalbavancin, telavancin, oritavancin, rifabutin, delafloxacin, eravacycline, clofazimine and bedaquiline using broth microdilution (Sensititre, Thermo Fisher). RESULTS A total of 218 M. abscessus complex isolates were included for retrospective review, of which 151 were respiratory isolates. Of these 218 isolates, 211 were available for additional testing with the extended antibiotic panel. Of these, 146 were respiratory isolates. One isolate had a vancomycin MIC of 2 mg/L and MICs of all other isolates were >8 mg/L. All isolates had MICs of >8 mg/L for oritavancin, dalbavancin and telavancin. One isolate had a delafloxacin MIC of 4 mg/L and MICs of all other isolates were >8 mg/L. The MIC50/MIC90s of rifabutin, tigecycline, eravacycline, clofazimine and bedaquiline were 16/32, 0.5/1, 0.12/0.25, 0.12/0.25 and 0.06/0.12 mg/L, respectively. CONCLUSIONS In vitro activity was demonstrated for clofazimine, bedaquiline and eravacycline, indicating potential for inclusion as standardized therapy for M. abscessus complex infections.
Collapse
Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Sophie Octavia
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Joelle Go
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Sally Ng
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Yit Er Tang
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Patsy Soh
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Joy Yong
- Department of Pharmacy, National University Hospital, Singapore, Republic of Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Raymond Tzer Pin Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Siang Fei Yeoh
- Department of Pharmacy, National University Hospital, Singapore, Republic of Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| |
Collapse
|
10
|
Guo Q, Wei J, Zou W, Li Q, Qian X, Zhu Z. Antimicrobial susceptibility profiles of Mycobacterium abscessus complex isolates from respiratory specimens in Shanghai, China. J Glob Antimicrob Resist 2021; 25:72-76. [PMID: 33689828 DOI: 10.1016/j.jgar.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the antibiotic susceptibility profiles of Mycobacterium abscessus complex (MABC) isolates and to investigate the relationship between susceptibility profiles and genetic mechanisms of macrolide resistance. METHODS More than 200 isolates collected from respiratory specimens between 2014 and 2018 were randomly analysed in this study. Minimum inhibitory concentrations (Mics) of ten potential antimicrobial agents were determined by the microplate alamarBlue assay. RESULTS We identified 43 MABC isolates, including 32 M. abscessus subsp. abscessus (M. abscessus) (6 from immunocompromised patients) and 11 M. abscessus subsp. massiliense (M. massiliense). The majority of MABC isolates were susceptible to amikacin (96.9% and 100.0% for M. abscessus and M. massiliense, respectively), linezolid (96.9% and 100.0%, respectively), cefoxitin (100.0% and 100.0%, respectively), imipenem (90.6% and 72.7%, respectively) and tobramycin (90.6% and 72.7%, respectively). The resistance rates to clarithromycin and doxycycline in isolates of M. abscessus (68.8% and 100.0%) were significantly higher than those in isolates of M. massiliense (18.2% and 63.6%) (P < 0.05), whereas the percentage of tobramycin-resistant isolates among M. abscessus (9.4%) was significantly lower than among M. massiliense (27.3%) (P = 0.007). Sequencing analyses showed significant differences between erm(41) of M. abscessus and M. massiliense. CONCLUSION Mycobacterium abscessus is the dominant pathogen of pulmonary MABC infections in our hospital. Aminoglycosides (amikacin and tobramycin), β-lactams (cefoxitin and imipenem) and linezolid exhibited potent inhibitory activity against MABC in vitro. The erm(41) gene may be a promising marker to predict macrolide susceptibility for M. abscessus.
Collapse
Affiliation(s)
- Qian Guo
- Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People's Republic of China; Department of Molecular Biology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Jianhao Wei
- Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People's Republic of China
| | - Wenda Zou
- Department of Reproductive Medicine Center, The Affiliated Zhuzhou Hospital, Xiang Ya Medical College, Central South University (CSU), Zhuzhou 412007, People's Republic of China
| | - Qiongxian Li
- Department of Clinical Laboratory, Nanhua County Center for Disease Control and Prevention, Chuxiong, Yunnan 675200, People's Republic of China
| | - Xueqin Qian
- Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People's Republic of China
| | - Zhaoqin Zhu
- Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People's Republic of China.
| |
Collapse
|
11
|
MIC Ranges of Quality Control Strain Mycobacterium peregrinum ATCC 700686 against Rifabutin, Eravacycline, Delafloxacin, Clofazimine, and Bedaquiline. J Clin Microbiol 2020; 59:JCM.02306-20. [PMID: 33055183 DOI: 10.1128/jcm.02306-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Andrews ER, Marchand-Austin A, Ma J, Cronin K, Sharma M, Brode SK, Marras T, Jamieson FB. Underutilization of nontuberculous mycobacterial drug susceptibility testing in Ontario, Canada, 2010-2015. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:77-86. [PMID: 36338182 PMCID: PMC9602888 DOI: 10.3138/jammi.2019-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/03/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND Drug susceptibility testing (DST) in nontuberculous mycobacterial pulmonary disease (NTM-PD) is useful for some Mycobacterium species. International guidelines recommend routine use of DST for clinically relevant mycobacteria. DST use and results are poorly studied at the population level. We sought to identify the frequency of DST utilization for nontuberculous mycobacteria (NTMs) and describe the potential relevance of these results in Ontario. METHODS Using public health laboratory data, we performed a population-based retrospective analysis of NTM DST utilization in Ontario from May 2010 to June 2015. We determined the proportion of incident NTM-PD infections for which DST was performed and analyzed minimum inhibitory concentration (MIC) distributions from NTM testing overall, using thresholds recommended by the Clinical and Laboratory Standards Institute. RESULTS The proportion of incident cases of NTM-PD tested for DST was 6.3% (240/3,806) for Mycobacterium avium complex (MAC), 36.2% (67/185) for M. abscessus, and 1.8% (19/1,057) for M. xenopi. Among specimens from all body sites, MAC resistance to clarithromycin occurred in 8.0% of specimens (21/262) and MAC resistance to amikacin (intravenous, MIC > 64 µg/mL) occurred in 22.6% (19/84). M. abscessus resistance occurred as follows: to amikacin, 3.8% (3/79); cefoxitin, 14.0% (11/79); imipenem, 30.4% (14/46); linezolid, 39.2% (31/79); clarithromycin, 54.2% (13/24); ciprofloxacin, 92.4% (73/79); and moxifloxacin, 91.1% (51/56). M. xenopi analysis was limited by few DST requests and a lack of DST clinical correlation. CONCLUSIONS We found that NTM DST is underutilized in Ontario and observed a very high frequency of amikacin resistance among MAC isolates.
Collapse
Affiliation(s)
- Elizabeth R Andrews
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jennifer Ma
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Meenu Sharma
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah K Brode
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Theodore K Marras
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joint Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Correspondence: Frances B Jamieson, Public Health Ontario, Public Health Ontario Laboratories, 661 University Avenue, Suite 1701, Toronto, Ontario M5G 1V2 Canada. Telephone: 672-792-3169. E-mail:
| | - Frances B Jamieson
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Kwon YS, Daley CL, Koh WJ. Managing antibiotic resistance in nontuberculous mycobacterial pulmonary disease: challenges and new approaches. Expert Rev Respir Med 2019; 13:851-861. [PMID: 31256694 DOI: 10.1080/17476348.2019.1638765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: The incidence and prevalence rates of nontuberculous mycobacterial (NTM) pulmonary disease have been continuously increasing worldwide. However, the rate of successful treatment of this disease greatly needs improving, particularly when intrinsic (natural) drug resistance and acquired drug resistance in NTM pulmonary disease are associated with poor outcomes for patients. Areas covered: This review covers the major pathogens that cause NTM pulmonary disease caused by Mycobacterium avium complex, Mycobacterium abscessus, and Mycobacterium kansasii; the key drugs and recommended regimens used in the treatment of NTM pulmonary disease; the factors that contribute to resistance to the key drugs, including genetic factors and monotherapy; and the treatment strategies, including revised antibiotic regimens and surgery, that can be used to treat drug-resistant NTM pulmonary disease. Expert opinion: To avoid and overcome drug resistance in NTM pulmonary disease, the appropriate guideline-based treatments are essential, and clinical studies to evaluate new or repurposed drugs are urgently needed.
Collapse
Affiliation(s)
- Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital , Gwangju , South Korea
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health , Denver , CO , USA
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| |
Collapse
|
14
|
Whole-Genome Sequencing for Predicting Clarithromycin Resistance in Mycobacterium abscessus. Antimicrob Agents Chemother 2018; 63:AAC.01204-18. [PMID: 30397069 DOI: 10.1128/aac.01204-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/25/2018] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium abscessus is emerging as an important pathogen in chronic lung diseases, with concern regarding patient-to-patient transmission. The recent introduction of routine whole-genome sequencing (WGS) as a replacement for existing reference techniques in England provides an opportunity to characterize the genetic determinants of resistance. We conducted a systematic review to catalogue all known resistance-determining mutations. This knowledge was used to construct a predictive algorithm based on mutations in the erm(41) and rrl genes which was tested on a collection of 203 sequentially acquired clinical isolates for which there were paired genotype/phenotype data. A search for novel resistance-determining mutations was conducted using a heuristic algorithm. The sensitivity of existing knowledge for predicting resistance in clarithromycin was 95% (95% confidence interval [CI], 89 to 98%), and the specificity was 66% (95% CI, 54 to 76%). The subspecies alone was a poor predictor of resistance to clarithromycin. Eight potential new resistance-conferring single nucleotide polymorphisms (SNPs) were identified. WGS demonstrated probable resistance-determining SNPs in regions that the NTM-DR line probe cannot detect. These mutations are potentially clinically important, as they all occurred in samples that were predicted to be inducibly resistant and for which a macrolide would therefore currently be indicated. We were unable to explain all resistance, raising the possibility of the involvement of other as yet unidentified genes.
Collapse
|
15
|
Tang YW, Cheng B, Yeoh SF, Lin RTP, Teo JWP. Tedizolid Activity Against Clinical Mycobacterium abscessus Complex Isolates-An in vitro Characterization Study. Front Microbiol 2018; 9:2095. [PMID: 30245674 PMCID: PMC6137136 DOI: 10.3389/fmicb.2018.02095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/16/2018] [Indexed: 12/23/2022] Open
Abstract
Mycobacterium abscessus complex consist of three rapidly growing subspecies: M. abscessus, M. massiliense, and M. bolletii. They are clinically important human pathogens responsible for opportunistic pulmonary and skin and soft tissue infections. Treatment of M. abscessus infections is difficult due to in vitro resistance to most antimicrobial agents. Tedizolid (TZD) is a next-generation oxazolidinone antimicrobial with a wide spectrum of activity even against multidrug resistant Gram-positive bacteria. In this study, the in vitro activity of TZD against the M. abscessus complex (n = 130) was investigated. Susceptibility testing by broth microdilution showed lower TZD minimum inhibitory concentrations (MICs) when compared to linezolid. The MIC50 and MIC90 was 1 mg/L and 4 mg/L, respectively across all M. abscessus complex members, reflecting no difference in subspecies response to TZD. Pre-exposure of M. abscessus complex to subinhibitory concentrations of TZD did not trigger any inducible drug resistance. Single-drug time kill assays and bactericidal activity assays demonstrated bacteriostatic activity of TZD in all three M. abscessus subspecies, even at high drug concentrations of 4 to 8x MIC. Combination testing of TZD with clarithromycin, doxycycline and amikacin using the checkerboard approach showed no antagonistic interactions. TZD may be an effective therapeutic antimicrobial agent for the treatment of M. abscessus infections.
Collapse
Affiliation(s)
- Ying Wei Tang
- Department of Biological Sciences, National University Singapore, Singapore, Singapore
| | - Bernadette Cheng
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Siang Fei Yeoh
- Pharmacy, National University Hospital, Singapore, Singapore
| | - Raymond T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore.,National Public Health Laboratory, Ministry of Health, Singapore, Singapore
| | - Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| |
Collapse
|