Abscessus infection: progress, but still progression

SESSION TITLE: Chest Infections Case Report Posters 16 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: M. abscessus subspecies asbcessus is a rapidly-growing non-tuberculosis mycobacteria (NTM) with increasing incidence and prevalence. It remains a challenging pathogen to treat due to its resistance profiles to available chemotherapeutic agents, with limited cure rates despite protracted courses of multidrug regimens and adjunctive surgical management. We present a case of M. abscessus subsp abscessus in a patient whose clinical symptoms improve only so long as she remains on parenteral antibiotics (even following surgical intervention), due to persistently positive cultures and progression of disease, and who is now being referred for phage therapy. CASE PRESENTATION: Patient is a 65yo woman with history of bronchiectasis diagnosed 10 years ago. Workup demonstrated Mycobacterium avium-intracellulare, which was treated for 14 months with resolution. She then grew Mycobacterium abscessus in 6/2013 and was treated with a variety of multidrug antibiotic regimens; each pause in therapy due to drug toxicity or frank intolerance was associated with worsening symptoms and CT imaging. Following her 4th episode of significant hemoptysis, patient underwent resection of her right upper and middle lobes in 2022 while continuing IV antibiotic therapy. Her symptoms improved significantly however sputum demonstrated persistence of M. abscessus infection 8 months post-surgery and CT imaging continues to show waxing and waning disease. Her isolate was tested to dual B-lactam antibiotic combinations and she is now on imipenem/cilastatin/relebactam, amoxicillin, omadacycline, and inhaled liposomal amikacin, although side effects prevent her from using the medications at their recommended dosage. Given her multilobar/cavitary disease, her persistent positive cultures and her borderline pulmonary function, we are very hesitant to transition her from her IV regimen to an oral/inhaled regimen. We are planning for phage therapy, but this has been delayed by logistical and regulatory obstacles, presenting additional barriers to treating her disease. DISCUSSION: M. Abscessus pulmonary disease can be very complex to treat. Despite aggressive antibiotic therapy and surgery, cure is difficult to achieve, even with symptom improvement (often requiring continued therapy), cultures often fail to convert. Heightened awareness of M abscessus as a clinically important entity, prompt/correct diagnosis, and early initiation of multidisciplinary interventions are instrumental in attempting to improve outcomes in this disease. CONCLUSIONS: Clinical symptoms of M. abscessus infection can be improved by lengthy courses of antibiotics coupled with surgery, although cure rates remain disappointingly low. There is a need to develop novel treatment modalities beyond traditional antibiotic therapy. REFERENCE #1: Lopeman RC, Harrison J, Desai M, Cox JAG. Mycobacterium abscessus: Environmental Bacterium Turned Clinical Nightmare. Microorganisms. 2019 Mar 22;7(3):90. doi: 10.3390/microorganisms7030090. PMID: 30909391; PMCID: PMC6463083. REFERENCE #2: Griffith DE, Daley CL. Treatment of Mycobacterium abscessus Pulmonary Disease. Chest. 2022 Jan;161(1):64-75. doi: 10.1016/j.chest.2021.07.035. Epub 2021 Jul 24. PMID: 34314673. REFERENCE #3: Lu M, Fitzgerald D, Karpelowsky J, Selvadurai H, Pandit C, Robinson P, Marais BJ. Surgery in nontuberculous mycobacteria pulmonary disease. Breathe (Sheff). 2018 Dec;14(4):288-301. doi: 10.1183/20734735.027218. PMID: 30519295; PMCID: PMC6269180. DISCLOSURES: Clinical Trial, I am PI relationship with Insmed Please note: 2017-2023 Added 04/01/2023 by Doreen Addrizzo-Harris, value=funds to my institution PI for research trial relationship with Hill-Rom Please note: 2019-2023 Added 04/01/2023 by Doreen Addrizzo-Harris, value=funds to my institution PI for research grant relationship with Zambone Please note: 2018-2021 by Doreen Addrizzo-Harris, value=funds to my institution PI of research trial relationship with Boehringer Please note: 2022-2023 Added 04/01/2023 by Doreen Addrizzo-Harris, value=funds to my institution Pi for a clinical trial; relationship with AN2 Please note: 2021 to present Added 11/13/2022 by Doreen Addrizzo-Harris, source=Web Response, value=Grant/Research Support No relevant relationships by robert james cerfolio No relevant relationships by Alexandria Imperato