No studies have reported therapies for the management of patients with refractory Mycobacterium abscessus pulmonary disease (MAB-PD). We implemented intermittent multi-drug intravenous therapy (IMIT) through repeated hospitalizations for MAB-PD patients who were refractory to antibiotics for over 12 months.
What are the effects of IMIT on patients with refractory MAB-PD.
The intravenous antibiotics administered for IMIT included amikacin, imipenem, and tigecycline, and the outcomes for 36 patients who underwent IMIT for refractory MAB-PD were evaluated. Patients were repeatedly hospitalized and administered IMIT upon recurrent symptoms or radiographic evidence of deterioration, while maintaining oral/inhaled antibiotics.
Of the 36 patients, 26 (72%) had M. abscessus subspecies abscessus (herein, M. abscessus)-PD, and 10 (28%) had M. abscessus subspecies massiliense (herein, M. massiliense)-PD. The median number of hospitalizations for IMIT was two (interquartile range [IQR] 1-3) for M. abscessus-PD patients and one (IQR 1-2) for M. massiliense-PD patients. At least one negative culture and culture conversion were observed in 62% and 12% of M. abscessus-PD patients, and in 80% and 60% of M. massiliense-PD patients, respectively. Symptomatic improvement was observed in all patients, and radiological improvement, including cavity amelioration or no deterioration, was observed in 42% and 70% of M. abscessus-PD and M. massiliense-PD patients, respectively. No resistance to clarithromycin or AMK was acquired.
IMIT with intermittent hospitalization can be a beneficial palliative treatment for refractory MAB-PD patients. This therapy alleviated symptoms, slowed radiological progression, and reduced the bacterial burden in some patients. However, radiological and microbiological responses by IMIT were more apparent in M. massiliense-PD than in M. abscessus-PD.

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