title: Mycobacterial Characteristics and Treatment Outcomes in Mycobacterium abscessus Lung Disease.
abstract: BACKGROUND
  Treatment outcomes of patients with Mycobacterium abscessus subspecies abscessus lung disease are poor, and the microbial characteristics associated with treatment outcomes have not been studied systematically. The purpose of this study was to identify associations between microbial characteristics and treatment outcomes in patients with M. abscessus lung disease.
  
  
  METHODS
  Sixty-seven consecutive patients with M. abscessus lung disease undergoing antibiotic treatment for ≥12 months between January 2002 and December 2012 were included. Morphotypic and genetic analyses were performed on isolates from 44 patients.
  
  
  RESULTS
  Final sputum conversion to culture negative occurred in 34 (51%) patients. Compared to isolates from 24 patients with persistently positive cultures, pretreatment isolates from 20 patients with final negative conversion were more likely to exhibit smooth colonies (9/20, 45% vs 2/24, 8%; P = .020), susceptibility to clarithromycin (7/20, 35% vs 1/24, 4%; P = .015), and be of the C28 sequevar with regard to the erm(41) gene (6/20, 30% vs 1/24, 4%; P = .035). Mycobacterium abscessus lung disease recurred in 5 (15%) patients after successful completion of antibiotic therapy. Genotypic analysis revealed that most episodes (22/24, 92%) of persistently positive cultures during antibiotic treatment and all cases of microbiologic recurrence after treatment completion were caused by different M. abscessus genotypes within a patient.
  
  
  CONCLUSIONS
  Precise identification to the subspecies level and analysis of mycobacterial characteristics could help predict treatment outcomes in patients with M. abscessus lung disease. Treatment failures and recurrences are frequently associated with multiple genotypes, suggesting reinfection.
  
  
  BACKGROUND
  NCT00970801.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Byeong-Ho
authors.initials: BH
authors.lastname: Jeong
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Su-Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.affiliation: Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine.
authors.forename: Kyoung Un
authors.initials: KU
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Byung Woo
authors.initials: BW
authors.lastname: Jhun
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Hyun
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Dae Hun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine and Genetics.
authors.forename: Hee Jae
authors.initials: HJ
authors.lastname: Huh
authors.affiliation: Department of Laboratory Medicine and Genetics.
authors.forename: Chang-Seok
authors.initials: CS
authors.lastname: Ki
authors.affiliation: Department of Laboratory Medicine and Genetics.
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.affiliation: Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.affiliation: Korean Institute of Tuberculosis, Cheongju, and.
authors.forename: Seung-Heon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Korean Institute of Tuberculosis, Cheongju, and.
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Kim
authors.affiliation: Department of Microbiology, Yonsei University College of Medicine, Seoul, South Korea; and.
authors.forename: Sung Jae
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Division of Mycobacterial and Respiratory Infections, Department of Medicine, National Jewish Health, Denver, Colorado.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D005838:Genotype; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D012008:Recurrence; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin
keywords: 
  Mycobacterium abscessus
  ; lung disease.; macrolides; nontuberculous mycobacteria