Friday, December 1, 2023
|
Reference |
Method |
Antimicrobial drug susceptibility† |
|---|---|---|
| Case report | Broth microdilution | Amikacin, ≤1, S; cefoxitin, 4, S; ciprofloxacin, ≤0.12, S; clarithromycin, 8, R; doxycycline, ≤0.12, S; imipenem, 0.12, S; linezolid, ≤1, S; moxifloxacin, 0.06, S; tigecycline, 0.12, no interpretation; TMP/SMX, 2/38, S |
| [6] | Agar dilution | Amikacin, 0.5, S; ciprofloxacin, 0.016, S; clarithromycin, 4, I; doxycycline, 0.064, S; linezolid, 0.25, S; meropenem, 0.25, S; moxifloxacin, 0.008, S; TMP/SMX, 0.25, S |
| [7] | Etest | Amikacin, S; clarithromycin, S; TMP/SMX, S |
| [8] | Disk diffusion | Amikacin, S; cefoxitin, S; doxycycline, S; imipenem, S; TMP/SMX, S |
| [9] | Etest | Amikacin, S; cefoxitin, S; ciprofloxacin, S; clarithromycin, S; imipenem, S; linezolid, S; TMP/SMX, R |
| [10] | Broth microdilution | Amikacin, S; cefoxitin, S; ciprofloxacin, S; clarithromycin, R; doxycycline, S; imipenem, S; linezolid, S; moxifloxacin, S; TMP/SMX, S |
| [11] | Disk diffusion | Amikacin, S; cefoxitin, S; ciprofloxacin, S; clarithromycin, R; imipenem, S; TMP/SMX, R |
| [12] | Broth microdilution | Amikacin, ≤8, S; cefoxitin, ≤16, S; ciprofloxacin, ≤1, S; doxycycline, ≤1, S; imipenem, ≤2, S; linezolid, ≤1, S; moxifloxacin, ≤0.5, S; TMP/SMX, 1/19, S |
| [13] | Not reported | Amikacin, R; ciprofloxacin, R; imipenem, R; TMP/SMX, R |
| [14] | Not reported | Amikacin, ≤1, S; cefoxitin, 8, S; ciprofloxacin, ≤0.12, S; clarithromycin, >4, R; doxycycline, ≤0.25, S |
| [14] | Not reported | Amikacin, 8, S; doxycycline, 0.5, S; linezolid, 1, S |
| [14] | Broth microdilution | Amikacin, 1, S; cefoxitin, 8, S; ciprofloxacin, 0.25, S; clarithromycin, 0.25, S; imipenem, 1, S; linezolid, 2, S |
| [15] | Not reported | Amikacin, ≤1, S; cefoxitin, 8, S; ciprofloxacin, 0.25, S; clarithromycin, >16, R; doxycycline, 1, S; imipenem, ≤2, S; linezolid, 4, S; moxifloxacin, ≤0.25, S; TMP/SMX, 0.5/9.5, S |
| [16] | Disk diffusion | Amikacin, S; ciprofloxacin, S; doxycycline, S; imipenem, S; meropenem, S; TMP/SMX, S |
| [17] | Etest | Ciprofloxacin, S; clarithromycin, R; doxycycline, S; imipenem, S |
| [18] | Broth microdilution | Amikacin, ≤1.0, S; cefoxitin, 32, I; ciprofloxacin, ≤0.125, S; clarithromycin, 2, S; doxycycline, ≤0.125, S; imipenem, 2, S; linezolid, <2, S; moxifloxacin, ≤0.125, S; TMP/SMX, 16/304, R |
| [19] | Not reported | Amikacin, ≤8, S; cefoxitin, ≤16, S; ciprofloxacin, ≤1, S; clarithromycin, 1, S; doxycycline, ≤1, S; imipenem, ≤2, S; linezolid, ≤1, S; moxifloxacin, ≤0.5, S; TMP/SMX, <0.5/9.5, S |
| [20] | Etest | Cefoxitin, 2, S; ciprofloxacin, 0.6, S; clarithromycin, 0.125, S; imipenem, 0.19, S; linezolid, 1.5, S; moxifloxacin, 0.2, S; TMP/SMX, 32, R |
| [21] | Broth microdilution | Amikacin, <1, S; cefoxitin, 8, S; clarithromycin, 2, S; imipenem, <2, S; linezolid, 2, S; meropenem, 2, S; moxifloxacin, ≤0.25, S; TMP/SMX, 1/19, S |
| [22] | Disk diffusion | Amikacin, S; clarithromycin, R; ciprofloxacin, S; doxycycline, S |
| [23] | Etest | Imipenem, 0.12, S |
Table. Methods of determination and antimicrobial drug susceptibilities of isolates from the current case and published reports of healthcare-associated infections caused by Mycolicibacterium neoaurum*
*Values for each antimicrobial drug are MICs in μg/mL. Etest, bioMérieux. I, intermediate; S, sensitive; R, resistant; TMP/SMX, trimethoprim/sulfamethoxazole.
†MICs were interpreted according to broth microdilution criteria in the Clinical and Laboratory Standards Institute guidelines for rapidly growing mycobacteria[4].
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
This activity is intended for infectious disease clinicians, intensivists, hematologists, internists, and other clinicians caring for patients with Mycolicibacterium neoaurum bloodstream infection.
The goal of this activity is for learners to be better able to describe demographic and clinical characteristics, diagnosis, and management of M neoaurum infection, based on a case report of a child with leukemia and catheter-related bloodstream infection and a case series of 36 previously reported episodes of M neoaurum infection.
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Mycolicibacterium neoaurum is a rapidly growing mycobacterium and an emerging cause of human infections. M. neoaurum infections are uncommon but likely underreported, and our understanding of the disease spectrum and optimum management is incomplete. We summarize demographic and clinical characteristics of a case of catheter-related M. neoaurum bacteremia in a child with leukemia and those of 36 previously reported episodes of M. neoaurum infection. Most infections occurred in young to middle-aged adults with serious underlying medical conditions and commonly involved medical devices. Overall, infections were not associated with severe illness or death. In contrast to other mycobacteria species, M. neoaurum was generally susceptible to multiple antimicrobial drugs and responded promptly to treatment, and infections were associated with good outcomes after relatively short therapy duration and device removal. Delays in identification and susceptibility testing were common. We recommend using combination antimicrobial drug therapy and removal of infected devices to eradicate infection.
Comprehensive phylogenetic and genomic studies support the division of the genus Mycobacterium into 5 main clades: the emended genus Mycobacterium, Mycolicibacter gen. nov, Mycolicibacillus gen. nov., Mycolicibacterium gen. nov., and Mycobacteroides gen. nov[1]. Mycolicibacterium spp. include rapidly growing mycobacteria (RGM) that are not part of the Mycobacterium abscessus complex (i.e., Mycobacteroides gen. nov., which includes M. abscessus, M. chelonae, M. franklinii, M. immunogenum, and M. saopaulense).
Mycolicibacterium spp. are considered to have low pathogenicity, but some are associated with human infection. Mycolicibacterium neoaurum, originally described by Tsukamura in 1972, is derived from the Greek word for new gold because of distinctive yellow-orange colonies[2]. Since its identification, increasing numbers of case reports and small case series of invasive M. neoaurum infections have been described. Infections are likely underrecognized because many laboratories do not identify all mycobacteria at the species level. Bacteremia might also be missed or isolates inappropriately dismissed as contaminants because mycobacteria might require longer culture incubation than conventional bacterial pathogens, and they are ubiquitous in the environment.
Although best practices for treating infections caused by more commonly reported RGM species are now recognized, our understanding of disease spectra and best infection management strategies for rarer RGM species, such as M. neoaurum, remains incomplete. Therefore, to improve clinical awareness of M. neoaurum, we summarized demographic and clinical characteristics of 36 previously reported episodes and report an additional case of M. neoaurum infection.
