Repeat Positive Cultures in Mycobacterium intracellulare Lung Disease after Macrolide Therapy Represent New Infections in Patients with Nodular Bronchiectasis

The genomic DNA patterns (genotypes) of 55 episodes of late positive sputum isolates, collected after ⩾4 consecutive months of negative sputum cultures, in prospective macrolide treatment trials of Mycobacterium avium complex (MAC) lung disease were assessed by pulsed-field gel electrophoresis (PFGE...

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Bibliographic Details
Published in:The Journal of infectious diseases 2002-07, Vol.186 (2), p.266-273
Main Authors: Wallace, Richard J., Zhang, Yansheng, Brown-Elliott, Barbara A., Yakrus, Mitchell A., Wilson, Rebecca W., Mann, Linda, Couch, Leslie, Girard, William M., Griffith, David E.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Azithromycin - administration & dosage
Azithromycin - therapeutic use
Bacterial diseases
Biological and medical sciences
Bronchiectasis
Bronchiectasis - complications
Clarithromycin - administration & dosage
Clarithromycin - therapeutic use
DNA, Bacterial - chemistry
DNA, Bacterial - genetics
Electrophoresis
Electrophoresis, Gel, Pulsed-Field
Female
Gels
Genotypes
Human bacterial diseases
Humans
Infections
Infectious diseases
Lung diseases
Lung Diseases - complications
Lung Diseases - drug therapy
Lung Diseases - microbiology
Major Articles
Male
Medical sciences
Middle Aged
Mycobacterium avium complex
Mycobacterium avium Complex - genetics
Mycobacterium avium Complex - isolation & purification
Mycobacterium avium-intracellulare Infection - complications
Mycobacterium avium-intracellulare Infection - drug therapy
Pharmacology. Drug treatments
Polymerase Chain Reaction
Pretreatment
Prospective Studies
Relapse
Sputum
Sputum - microbiology
Tuberculosis and atypical mycobacterial infections
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Summary:The genomic DNA patterns (genotypes) of 55 episodes of late positive sputum isolates, collected after ⩾4 consecutive months of negative sputum cultures, in prospective macrolide treatment trials of Mycobacterium avium complex (MAC) lung disease were assessed by pulsed-field gel electrophoresis (PFGE). Having ⩾2 cultures positive for MAC after completion of therapy was documented 23 times; of 20 episodes studied by PFGE, 17 (85%) represented new genotypes (i.e., new infections), and 87% occurred in patients with nodular bronchiectasis. With ⩾2 positive cultures after therapy was stopped prematurely, 6 (86%) of 7 episodes were relapses. Single positive cultures after completion of therapy occurred 16 times; only 1 (6%) was predictive of a subsequent relapse. No late isolates were macrolide resistant. Thus, relapses of MAC lung disease with these macrolide regimens are unusual, and most infections after completing therapy resulted from new strains in patients with nodular bronchiectasis
ISSN:0022-1899
1537-6613
DOI:10.1086/341207