Mycobacterium abscessus Associated Peritonitis with CAPD Successfully Treated Using a Linezolid and Tedizolid Containing Regimen Suggested Immunomodulatory Effects

Abstract

Objective: Rare disease Background: Mycobacterium abscessus is one of the most important mycobacteria, but its associated peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) appears relative rare, and the treatment regimen of the antibiotics are still unclear. Case Report: A 38-year-old female with chronic glomerulonephritis on CAPD who was diagnosed with M. abscessus-associated peritonitis. Symptoms exacerbated despite treatment with a 3-antibiotic regimen combining clarithromycin, imipenem/cilastatin (IPM/CS), and minocycline (MINO). However, after changing IPM/CS and MINO to linezolid (LZD), her condition and inflammation improved, and she was able to be maintained on oral tedizolid (TZD). Conclusions: Oxazolidinones such as LZD and TZD might be candidate antibiotics for the treatment of M. abscessus-associated diseases with chronic renal failure due to their immunomodulatory effects and non-renal excretion.

Severe Pulmonary Mycobacterium abscessus Cases Due to Co-Infection with Other Microorganisms Well Treated by Clarithromycin and Sitafloxacin in Japan

“…2 This rapidly growing mycobacterium is one of the most commonly identified NTM species responsible for severe respiratory, skin and mucosal infections in humans, and is frequently found in immunocompromised patients with underlying diseases and complicated coinfections. 3,4 Although M. abscessus is usually treated with a combination of antibiotics, including macrolides, carbapenems and aminoglycosides, it is often regarded as one of the most antibiotic-resistant mycobacteria, with few therapeutic options. 5 Recently, some quinolones, including levofloxacin (LVFX), have demonstrated antimycobacterial activities and degrees of chemotherapeutic efficacy against certain types of mycobacterial infections, and are used as an alternative to and/or as combination agents with antimycobacterial agents, such as isoniazid, rifampicin and ethambutol, although the NTM are sometimes resistant.…”

“…Additionally, difficulty in outpatient control has been suggested because most of the recommended drugs are not oral agents, and because of the significant side-effects, including thrombocytopenia with LZD. 4 Therefore, some other antimicrobial agents, including fluoroquinolones, were suggested as key agents for the long term treatment and maintenance follow up of M. abscessus infections. Among the fluoroquinolones, SFTX is considered a favorable agent against M. abscessus because it shows high susceptibility/low MIC in contrast to the other fluoroquinolones, including LVFX.…”

Management of peritoneal dialysis Mycobacterium abscessus exit-site infection: A case report and literature review

“…11 Meanwhile, with cefoxitin resistance, oxazolidinones like linezolid are considered empirically and have been used successfully in M. abscessus PD-associated infections, as there is moderate in vitro susceptibility, immunomodulation, clearance via multiple organs, and an oral formulation ideal for long term use. 12 The ideal duration of multidrug antibiotics in M. abscessus PD-associated infections is unknown, particularly in ESI. M. abscessus intrinsic antibiotic resistance and recurrence of infection after cessation of antibiotics necessitates urgent PD catheter removal.…”

Alternative and Experimental Therapies of Mycobacterium abscessus Infections

“…Report of one immune-compromised patient [39] Delpazolid (PO/IV) Active against reference strain and 8 clinical strains. Noted spontaneous resistance to delpazolid [40] Intracellular effect in a macrophage model [40] Comparable effect of delpazolid to linezolid in a murine model [40].…”

“…Clinical reports of treating M. abscessus infection with tedizolid are extremely limited. Of note, one report described successful tedizolid treatment of an M. abscessus infection in an immunocompromised host [39].…”