Resistance mechanisms and drug susceptibility testing of nontuberculous mycobacteria

Nontuberculous mycobacteria (NTM) are increasingly recognized as causative agents of opportunistic infections in humans. For most NTM infections the therapy of choice is drug treatment, but treatment regimens differ by species, in particular between slow (e.g. Mycobacterium avium complex, Mycobacter...

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Published in:Drug resistance updates Vol. 15; no. 3; pp. 149 - 161
Main Authors: van Ingen, Jakko, Boeree, Martin J., van Soolingen, Dick, Mouton, Johan W.
Format: Journal Article
Language:English
Published: Scotland Elsevier Ltd 01.06.2012
Subjects:
Animals
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Drug Resistance, Bacterial
Drug susceptibility
Hematology, Oncology and Palliative Medicine
Humans
Infectious Disease
Macrolides
Microbial Sensitivity Tests - methods
Mycobacteria
Mycobacterium Infections, Nontuberculous - drug therapy
Mycobacterium Infections, Nontuberculous - microbiology
Nontuberculous mycobacteria
Nontuberculous Mycobacteria - drug effects
Resistance
Resistance
Drug susceptibility
Macrolides
Mycobacteria
Nontuberculous mycobacteria
ISSN:1368-7646, 1532-2084, 1532-2084
Online Access:Get full text
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Summary:Nontuberculous mycobacteria (NTM) are increasingly recognized as causative agents of opportunistic infections in humans. For most NTM infections the therapy of choice is drug treatment, but treatment regimens differ by species, in particular between slow (e.g. Mycobacterium avium complex, Mycobacterium kansasii) and rapid growers (e.g. Mycobacterium abscessus, Mycobacterium fortuitum). In general, drug treatment is long, costly, and often associated with drug-related toxicities; outcome of drug treatment is poor and is likely related to the high levels of natural antibiotic resistance in NTM. The role of drug susceptibility testing (DST) in the choice of agents for antimicrobial treatment of NTM disease, mainly that by slow growers, remains subject of debate. There are important discrepancies between drug susceptibility measured in vitro and the activity of the drug observed in vivo. In part, these discrepancies derive from laboratory technical issues. There is still no consensus on a standardized method. With the increasing clinical importance of NTM disease, DST of NTM is again in the spotlight. This review provides a comprehensive overview of the mechanisms of drug resistance in NTM, phenotypic methods for testing susceptibility in past and current use for DST of NTM, as well as molecular approaches to assess drug resistance.
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ISSN:1368-7646
1532-2084
1532-2084
DOI:10.1016/j.drup.2012.04.001