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A 15-year-old patient with cystic fibrosis with a disseminated Mycobacterium abscessus infection was treated with a three-phage cocktail following bilateral lung transplantation. Effective lytic phage derivatives that efficiently kill the infectious M. abscessus strain were developed by genome engineering and forward genetics. Intravenous phage treatment was well tolerated and associated with objective clinical improvement, including sternal wound closure, improved liver function, and substantial resolution of infected skin nodules. Clinical use of engineered bacteriophages for the treatment of disseminated mycobacterial infection.

Mycobacterium abscessus is a rapidly growing, multidrug-resistant mycobacteria, commonly associated with pulmonary, skin, and soft tissue infections. We describe a rare case of M abscessus endovascular stent infection; only 3 cases of graft infections have previously been reported.

Contains fulltext : 177569.pdf (Publisher’s version ) (Open Access) A disseminated peritoneal dialysis-related Mycobacterium abscessus infection is very rare. M. abscessus belongs to the rapidly growing mycobacteria and can be misidentified as a diphtheroid bacterium, which in our case delayed diagnosis and optimal treatment. Due to intrinsic resistance to most antimicrobials, therapeutic options in M. abscessus infections are limited. Infection often leads to catheter loss. A fatal outcome, like in our case, is not exceptional.

Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium of low virulence that is capable of causing disseminated infections in the immunocompromised host. These infections require multiple antimicrobial agents for effective therapy, with difficulty in eradicating the pathog

Background AMK exhibits concentration-dependent bactericidal activity where larger intermittent doses with higher peaks (Cmax) may be less toxic than more frequent dosing while achieving similar efficacy. An AMK containing regimen was used for treatment of M. abscessus odontogenic outbreak infections in children. Additionally, synergy has been observed between AMK and clofazimine (CFZ). Previous reports of daily AMK for M. abscessus infection in children resulted in high rates of toxicity. This is the first report of PK and safety of AMK dosed TIW for disseminated M. abscessus infections in children. Methods Treatment regimen initially included high dose AMK TIW with azithromycin (AZM) and a β-lactam followed by lower dose AMK with CFZ and AZM. Data collected included demographics, weekly laboratories, treatment details and adverse effects. AMK levels were drawn at 2- and 6-hour postdose for PK determination and to attain a Cmax of 8 × minimum inhibitory concentration. Audiograms were obtained every 2 weeks. Results Of 27 children who received treatment, 13 were male, mean age was 5.8 years (3.0–9.4 years) and mean weight was 21.4 kg (14–37 kg). Dissemination (lung nodules (16 [59.3%]) and granulomatous cervical lymphadenitis (10 [37%]) was common. All patients underwent oral surgical debridement. Mean total treatment duration was 135 ± 19 days (mean ± SD). Initial AMK dose was 23.7 ± 5 mg/kg to achieve a Cmax 58.7 ± 6.3 mg/L. Dosage was reduced to 12.6 ± 2.2 mg/kg after addition of CFZ at 65 ± 14 days to target Cmax 25 ± 5 mg/L. No nephrotoxicity was noted, however a transient increase in serum creatinine of 50% from baseline was seen in seven (25%) patients. Two children experienced mild–moderate hearing loss during treatment which normalized by final audiogram. All children showed evidence of jaw healing with resolved or improving lung nodules at 12-months follow-up. Conclusion TIW AMK containing regimen is well tolerated and potentially less toxic than daily dosing for treatment of M. abscessus infection in children. AMK PK Parameters (Mean ± SD) k e (hour−1) t 1/2 (hour) V d (L/kg) C max (mg/L) CL (mL/minute) AUC (mg hour/L) 0.46 ± 0.07 1.5 ± 0.25 0.38 ± 0.11 58.7 ± 6.3 59.3 ± 17.7 145.6 ± 24.6 Disclosures A. Arrieta, Melinta Therapeutics: Investigator, Research support.

We present the case of a 44-year-old woman admitted to our institution with fever, constitutional symptoms, pancytopenia, and splenomegaly. A bone marrow was diagnostic of hairy cell leukemia. The patient was also found to be bacteremic with Mycobacterium abscessus, a highly unusual pathogen in this setting. She responded initially to 4-drug therapy and subsequently was discharge on monotherapy. A review of the case and literature is presented.