Mycobacterium abscessus: an emerging rapid-growing potential pathogen.
Mycobacterium abscessus is the most pathogenic and chemotherapy-resistant rapid-growing mycobacterium. It is commonly associated with contaminated traumatic skin wounds and with post-surgical soft tissue infections. It is also one of the mycobacteria that are most often isolated from cystic fibrosis patients. It is essential to differentiate this species from the formerly indistinct "M. chelonae-complex", as chemotherapy is especially difficult in M. abscessussenso strictu. Clarithromycin or azithromycin are the only regular oral antimycobacterial agents with an effect on M. abscessus, and should preferably be supplemented with other drugs since long-term monotherapy may cause resistance. Amikacin is a major parenteral drug against M. abscessus that should also be given in combination with another drug. The recently introduced drug tigecycline may prove to be an important addition to chemotherapy, but has yet to be fully clinically evaluated as an antimycobacterial agent. Surgery can be curative, or at least helpful, in the healing of M. abscessus infection, and if conducted, it should include the removal of all foreign or necrotic material. There is increasing awareness of M. abscessus as an emerging pathogen.
Petrini
Björn
B
Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden. bjorn.petrini@karolinska.se
D000284:Administration, Oral; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology / Q000627:therapeutic use; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000150:complications; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000031:analogs & derivatives / Q000494:pharmacology; D009161:Mycobacterium / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000382:microbiology* / Q000628:therapy; D012141:Respiratory Tract Infections / Q000209:etiology / Q000382:microbiology; D012867:Skin / Q000293:injuries; D018461:Soft Tissue Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D013045:Species Specificity; D013530:Surgical Wound Infection / Q000382:microbiology / Q000628:therapy; D000078304:Tigecycline; D014382:Tuberculosis, Cutaneous / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications
D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D017963:Azithromycin; D000583:Amikacin; D008911:Minocycline; D017291:Clarithromycin