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Imipenem–Cilastatin and Imipenem–Relebactam
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Yoshiro Hayashi, David L. Paterson
Rapidly growing mycobacteria, including Mycobacterium fortuitum, Mycobacterium chelonae and Mycobacterium abscessus, are variably susceptible to imipenem (Brown-Elliott and Wallace, 2002; Uslan et al., 2006; Huang et al., 2008). Typically, greater than 90% of M. fortuitum group are susceptible to imipenem, whereas 40–60% of M. chelonae or M. abscessus are susceptible (Brown-Elliott and Wallace, 2002). Mycobacterium marinum, which causes swimming pool granuloma or fish tank granuloma, is relatively sensitive to imipenem (MIC50 2 µg/ml, MIC90 8 µg/ml; MIC range: 0.5–16 µg/ml) (Aubry et al., 2000). Resistance of Mycobacterium tuberculosis to beta-lactam antibiotics (such as imipenem) is thought to be mediated by a class A beta-lactamase. The critical resistance factor is the constitutive production of a chromosomally encoded, Ambler class A beta-lactamase, BlaC in M. tuberculosis. BlaC is a beta-lactamase with high levels of penicillinase and cephalosporinase activity as well as measurable activity against carbapenems, including imipenem (Hugonnet and Blanchard, 2007). Despite this, imipenem had antimycobacterial activity both in a mouse model and in humans at high risk for failure of treatment for multidrug-resistant (MDR) tuberculosis (Chambers et al., 2005; Hugonnet and Blanchard, 2007).
Lung transplantation for cystic fibrosis and bronchiectasis
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Mycobacterium abscessus is another organism associated with more rapid disease progression; hence, it is being seen in increasing numbers of patients. No consensus regarding the acceptability of such candidates exists, but numerous anecdotal descriptions of multiple postoperative recurrences, typically in the form of chest wall masses and unremitting wound destruction, do exist. Only one series has been reported; consequently, little evidence on which to base advice is available. It is suggested that treatment be well established before transplantation. Eradication is possible but may take as long as 2 years. Disease that continues to progress before transplantation despite treatment should be regarded as a contraindication, and patients who are not tolerant of treatment similarly should not be accepted.8 The whole field of nontuberculous mycobacteria in patients with CF has recently been reviewed.13
Complications of Cardiac and Lung Transplantation
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Jay D. Pal, Daniel T. DeArmond, Hao Pan, Scott B. Johnson
CF patients have the potential for the greatest benefit from lung transplant though referrals are often delayed due to the young age of these patients. Indications for lung transplantation in patients with CF include FEV1 <30% of predicted, rapidly declining lung function, and/or any of the following: increasing oxygen requirements, hypercapnia, or pulmonary hypertension. Female patients and patients <18 years of age have poorer prognosis and may be candidates for earlier listing. CF patients have frequent respiratory infections and bacterial colonization, which have the potential to adversely impact posttransplant survival. Patients with pulmonary infections due to Burkholderia cepacia have been observed to have a 1-year survival of 50%–67% compared with 80%–93% survival at 1 year in CF patients without this organism, which may affect the decision to proceed with transplantation in these patients; B. cenocepacia and B. gladioli infections also portend a poorer survival after lung transplant in patients with CF. The presence of Mycobacterium abscessus in bronchial cultures is considered by some centers as a relative contraindication to lung transplantation. Aspergillus species are present in the respiratory cultures of up to 50% of CF patients and though this presents an increased risk of Aspergillus anastomotic infections or pneumonia, it is not a contraindication of lung transplant nor is pan-resistant Pseudomonas, which is also commonly cultured in the respiratory tract of CF patients.
Mycobacterium abscessus felon complicated with osteomyelitis: not an ordinary nail salon visit
Published in Acta Clinica Belgica, 2020
Jose Armando Gonzales Zamora, Abelardo Villar Astete
Final cultures revealed Mycobacterium abscessus complex. Identification of species was done by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF). Susceptibility testing by broth microdilution method (SENSITITRE®) revealed resistance to ciprofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole, doxycycline, and minocycline. Intermediate resistance was reported for imipenem and Cefoxitin. The organism was fully susceptible to amikacin, clarithromycin, and linezolid. Breakpoints from CLSI (Clinical and Laboratory Standards Institute) were used for antimicrobial susceptibility interpretation. In regards to tigecycline, the reported MIC was 0.25 (no interpretation was provided by CLSI) (Table 1). Of note, there are no established breakpoints from EUCAST (European Committee on Antimicrobial Susceptibility Testing) for rapidly growing mycobacteria.
State-of-the-art treatment strategies for nontuberculous mycobacteria infections
Published in Expert Opinion on Pharmacotherapy, 2020
Maria-Carmen Muñoz-Egea, Nerea Carrasco-Antón, Jaime Esteban
There have been no official novelties in the treatment of NTM infections over recent years. Recent British guidelines (the last ones to appear) recommended therapeutic schemes similar to those of former IDSA/ATS ones, that is therapy based on a combination of different drugs, usually rifampin or similar, ethambutol and clarithromycin for most slowly growing mycobacteria and combinations including quinolones and/or macrolides for rapidly growing ones. However, the actual importance of these organisms seems to be increasing and some of them (Mycobacterium chimaera, Mycobacterium abscessus) can be considered as emerging pathogens. Moreover, we have especially worrying news for some patients: Mycobacterium abscessus is an extremely difficult-to-treat pathogen that poses a threat today. In this sense, it is extremely important to reach an etiological diagnosis of these infections, as treatment differs greatly depending on the species. Moreover, for some NTM (especially rapidly growing organisms), reaching a subspecies level of identification and performing antimicrobial susceptibility testing is necessary in order to select the best available chemotherapy.
Looking for Ocular Tuberculosis: Prevalence and Clinical Manifestations of Patients with Uveitis and Positive QuantiFERON®-TB Gold Test
Published in Ocular Immunology and Inflammation, 2018
Kessara Pathanapitoon, Paradee Kunavisarut, Wasna Sirirungsi, Aniki Rothova
General characteristics of 108 patients with uveitis (63 males and 45 females, average age 40.5 years) are given in Table 2. The QFT-G test was positive in 39/108 (36%) and TST in 16/108 (15%) of all included patients. Out of these, both tests were positive in 13/108 (12%) patients (10 with uveitis of unknown cause and three with toxoplasma chorioretinitis). The QFT-G test was negative in 69/108 patients (64%). Three patients had a diagnosis of active systemic TB prior to the onset of their uveitis (pulmonary involvement in two cases and lymph node involvement in one case; two finished the treatment before the onset of uveitis and the other was still undergoing treatment). In total, four patients had radiologic signs compatible with old inactive TB infection. No additional patients with clinical, radiologic or microbiologic signs of active systemic TB were identified. One patient was diagnosed with atypical Mycobacterium abscessus infection (proven by sputum culture; Figure 1A,B).