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Mycobacterium abscessusis the second most common nontuberculous mycobacterium respiratory pathogen and shows in vitro resistance to nearly all oral antimicrobials. M abscessustreatment success is low in the presence of macrolide resistance.

Isolation of Mycobacterium abscessussubspecies abscessus(MAA) is common during Mycobacterium aviumcomplex (MAC) lung disease therapy, but there is limited information about the clinical significance of the MAA isolates.

There is no large study validating the appropriateness of current treatment guidelines for Mycobacterium aviumcomplex (MAC) lung disease. This is a retrospective single-center review evaluating the efficacy of macrolide/azalide-containing regimens for nodular/bronchiectatic (NB) MAC lung disease.

We prospectively evaluated 55 patients (58 studies) who presented for diagnostic fiberoptic bronchoscopy for the presence of lower respiratory tract infection. A sheathed, nonplugged, sterile brush passed transbronchoscopically under fluoroscopic control was used to retrieve bronchial secretions. These were evaluated using Gram stains, Wright-Giemsa stains, and quantitative bacterial cultures. In 18 studies of patients with known or suspected infection, polymorphonuclear leukocytes and bacteria were easily identifiable on Gram stain, and potential lower respiratory pathogens were recovered in concentrations ≥ 106colony-forming units (cfu)/ml. In 15 control studies of patients with noninfectious lung disease and in 17 studies of patients with suspected lung infection (nine with prior antibiotic therapy), organisms were not seen on Gram stain and in 28/32 studies bacteria were present in concentrations of ≤ 104cfu/ml. The remaining eight studies were in patients proved to have active granulomatous disease. These studies establish the ability of a fiberoptic bronchoscopic technique to diagnose bacterial infection in a group of patients presenting difficult diagnostic problems.

In the CONVERT study, treatment with amikacin liposome inhalation suspension (ALIS) added to guideline-based therapy (GBT) met the primary end point of increased culture conversion by month 6 in patients with treatment-refractory Mycobacterium aviumcomplex (MAC) lung disease (ALIS+GBT, 29% [65/224] vs GBT-alone, 8.9% [10/112], P<.0001).