Omadacycline improves quality of life for people with M. abscessus infection compared with a placebo. Recent findings support the potential utility of omadacycline as a therapeutic option to cure M. abscessus infection.
In this large, randomised, double-blind clinical trial, the oral tablet of omadacycline was significantly more effective than placebo in reducing disease severity and improving outcomes in patients with MABA-positive pulmonary disease.
The most common site of infection in these cases is not associated with an underlying medical condition in the majority of patients and is usually superficial and noncontagious. In a recent study, findings suggest that infections by M. abscessus could be a part of the usual natural flora and do not necessarily have a pathogenetic significance.
MA infection must be excluded when choosing antimicrobial therapy based on clinical and microbiological criteria. The use of macrolide-resistant (ML) M. abscessus should thus be avoided unless there are no other reliable alternatives.
Mycobacterium abscessus is a clinically significant human pathogen frequently encountered in clinical and environmental samples. Clinicians are advised that many antibiotics used for common bacterial infections have a minimal effect against abscess pathogens and that alternative therapies should be explored as potential therapeutic options.
Mycobacterium abscessus infection cannot be cured. Clinicians should assess for the need of treatment and consider the potential for recurrence of disease in some patients.
Mycobacterium abscessus infection is probably underestimated, because of difficulties in the identification of M. abscessus and a general lack of understanding about the significance of M. abscessus infection. M. abscessus can present with disease that mimics mycobacterial infection, therefore, it is important to use appropriate diagnostic methods. If diagnostic methods are only used for patients who fail to respond to treatment, most cases of M. abscessus infection will probably not be detected. Furthermore, patients with a recent history of exposure to M. abscessus infection should be tested for M. abscessus infection.
Early manifestations of infection include persistent cough, weight loss and fatigue. Other signs include persistent fever and swollen lymph nodes in the neck, axilla or armpit. Later signs include swollen jaw and trismus. These signs are non-specific and do not reliably differentiate mycobacterium abscessus infection from other causes of similar clinical symptoms. Definitive diagnosis of M. abscessus is difficult because it takes 6–8 weeks for culture to be positive, with delays up to 4–6 weeks. This delay, together with difficulty with accurate diagnosis, contributes to the incidence of infection that often goes untreated. Further research is needed to elucidate the incidence of M.
Recent findings demonstrates efficacy of oral at least 8-week-therapeutic doses of omadacycline for treatment of pulmonary and extra-pulmonary AB. Omadacycline has a unique mechanism of action which is clinically useful when treating antibiotic-resistant pathogens.
M. abscessus infections occurred most frequently in non-native Vietnamese persons without known respiratory disease. Infection risk factors included prolonged exposure to immunosuppressive therapies, dialysis, and long hospitalizations, and colonization of M. abscessus in the upper airways (such as the nose and paranasal sinuses) tended to be a significant risk of infection.
In one third of patients, invasive disease progresses to septic shock, requiring aggressive antimycobacterial treatment. In patients in whom antimycobacterial drug resistance is determined in clinical practice, the emergence of antimycobacterial drug intolerance is common and is associated with worse outcome after treatment. The clinical relevance of M. abscessus is uncertain.
There is a need to standardise patient selection criteria for clinical trials of M. abscessus infections. Clinics should consider including patients with COPD and/or the following characteristics before applying these criteria: pulmonary and systemic signs of disease, a known prior positive M. kansasii culture test, isolation of M. abscessus in two sputum or bronchoalveolar lavage samples, positive sputum cilia smear if M. kansasii was not isolated, isolation of M. abscessus in two sputum samples, a chest X-ray showing a multilobar infiltrative pattern and presence of an abscess or consolidation.