Mycobacterium abscessus complex infections: A retrospective cohort study

Maroun Sfeir, Marissa Walsh, Rossana Rosa, Laura Aragon, Sze Yan Liu, Timothy Cleary, Marylee Worley, Corey Frederick, Lilian Abbo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background. Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States. Methods. A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement. Results. One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53-81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4-31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7-23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6-21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9-21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2-3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57-18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002-1.8; P = .04). Conclusions. Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

Original languageEnglish (US)
Article numberofy022
JournalOpen Forum Infectious Diseases
Volume5
Issue number2
DOIs
StatePublished - Feb 1 2018

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Mycobacterium
Cohort Studies
Retrospective Studies
Odds Ratio
Confidence Intervals
Infection
Treatment Failure
Clarithromycin
Amikacin
Macrolides
Sulfamethoxazole Drug Combination Trimethoprim
Immunosuppressive Agents
Therapeutics
Mycobacterium Infections
Fluoroquinolones
Organ Transplantation
Ciprofloxacin
Hospital Mortality
Hispanic Americans
Acute Kidney Injury

Keywords

  • Clinical outcome
  • Epidemiology
  • Erm gene
  • Infections
  • Mycobacterium abscessus
  • Treatment failure

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Mycobacterium abscessus complex infections : A retrospective cohort study. / Sfeir, Maroun; Walsh, Marissa; Rosa, Rossana; Aragon, Laura; Liu, Sze Yan; Cleary, Timothy; Worley, Marylee; Frederick, Corey; Abbo, Lilian.

In: Open Forum Infectious Diseases, Vol. 5, No. 2, ofy022, 01.02.2018.

Research output: Contribution to journalArticle

Sfeir, M, Walsh, M, Rosa, R, Aragon, L, Liu, SY, Cleary, T, Worley, M, Frederick, C & Abbo, L 2018, 'Mycobacterium abscessus complex infections: A retrospective cohort study', Open Forum Infectious Diseases, vol. 5, no. 2, ofy022. https://doi.org/10.1093/ofid/ofy022
Sfeir, Maroun ; Walsh, Marissa ; Rosa, Rossana ; Aragon, Laura ; Liu, Sze Yan ; Cleary, Timothy ; Worley, Marylee ; Frederick, Corey ; Abbo, Lilian. / Mycobacterium abscessus complex infections : A retrospective cohort study. In: Open Forum Infectious Diseases. 2018 ; Vol. 5, No. 2.
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abstract = "Background. Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States. Methods. A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement. Results. One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8{\%}) were females, and 41 (38{\%}) Hispanics. Eleven (10.2{\%}) had end-stage renal disease, 34 (31.5{\%}) were on immunosuppressive therapy, and 40{\%} had chronic lung disease. Fifty-nine organisms (54.6{\%}) were isolated in respiratory sources, 21 (19.4{\%}) in blood, 10 (9.2{\%}) skin and soft tissue, and 9 (8.3{\%}) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3{\%}) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8{\%}, 93.8{\%}, and 89.1{\%}, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6{\%}) was susceptible to ciprofloxacin. Thirty-six (33.3{\%}) patients early failed treatment; of those, 17 (15.7{\%}) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95{\%} confidence interval [CI], 1.53-81.69; P = .04), acute kidney injury (OR, 6.55; 95{\%} CI, 2.4-31.25; P = .018), organ transplantation (OR, 2.37; 95{\%} CI, 2.7-23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95{\%} CI, 1.6-21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95{\%} CI, 0.9-21; P = .04), clarithromycin resistance (OR,79.5; 95{\%} CI, 6.2-3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95{\%} CI, 1.57-18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95{\%} CI, 0.002-1.8; P = .04). Conclusions. Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7{\%}. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.",
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T1 - Mycobacterium abscessus complex infections

T2 - A retrospective cohort study

AU - Sfeir, Maroun

AU - Walsh, Marissa

AU - Rosa, Rossana

AU - Aragon, Laura

AU - Liu, Sze Yan

AU - Cleary, Timothy

AU - Worley, Marylee

AU - Frederick, Corey

AU - Abbo, Lilian

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background. Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States. Methods. A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement. Results. One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53-81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4-31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7-23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6-21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9-21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2-3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57-18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002-1.8; P = .04). Conclusions. Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

AB - Background. Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States. Methods. A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement. Results. One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53-81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4-31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7-23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6-21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9-21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2-3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57-18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002-1.8; P = .04). Conclusions. Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

KW - Clinical outcome

KW - Epidemiology

KW - Erm gene

KW - Infections

KW - Mycobacterium abscessus

KW - Treatment failure

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