Successful use of azithromycin for Escherichia coli–associated renal allograft malakoplakia: a report of two cases

Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials with intracellular activity, reduction in immunosuppression, and debulking of lesions. Azithromycin has an intracellular mechanism of...

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Bibliographic Details
Published in:European journal of clinical microbiology & infectious diseases 2021-12, Vol.40 (12), p.2627-2631
Main Authors: Kinsella, Paul M., Smibert, Olivia C., Whitlam, John B., Steven, Mark, Masia, Ricard, Gandhi, Ronak G., Kotton, Camille N., Holmes, Natasha E.
Format: Article
Language:English
Subjects:
Allografts - microbiology
Anti-Bacterial Agents - administration & dosage
Antibiotics
Antiinfectives and antibacterials
Antimicrobial agents
Azithromycin
Azithromycin - administration & dosage
Biomedical and Life Sciences
Biomedicine
Breakpoints
Brief Report
Chronic granulomatous disease
E coli
Epidemiology
Escherichia coli
Escherichia coli - drug effects
Escherichia coli - genetics
Escherichia coli - physiology
Escherichia coli Infections - drug therapy
Escherichia coli Infections - microbiology
Female
Humans
Immunosuppression
Internal Medicine
Intracellular
Kidney transplantation
Kidney Transplantation - adverse effects
Malacoplakia
Malacoplakia - drug therapy
Malacoplakia - etiology
Malacoplakia - microbiology
Medical Microbiology
Microbial Sensitivity Tests
Middle Aged
Postoperative Complications - drug therapy
Postoperative Complications - etiology
Postoperative Complications - microbiology
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Summary:Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials with intracellular activity, reduction in immunosuppression, and debulking of lesions. Azithromycin has an intracellular mechanism of action and enhanced Gram-negative activity compared to other macrolides. Despite some in vitro data to support its use, there are no clinical breakpoints or epidemiological cut-off values for most Enterobacterales from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) or the Clinical and Laboratory Standards Institute (CLSI). We present two cases, previously unreported, of Escherichia coli associated renal allograft malakoplakia successfully treated with azithromycin.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-021-04270-x