Reactions 1704, p108 - 2 Jun 2018 Acquired resistance to antimicrobials: case report A 39-year-old woman developed acquired resistance following treatment with clarithromycin, ethambutol and rifampicin for pulmonary Mycobacterium heckeshornense (M. heckeshornense) infection [routes and time to reaction onset not stated]. The woman was hospitalised for further examinations following an abnormal chest radiograph, in 2012. She was initiated on antimicrobial therapy with rifampicin 450 mg/day and ethambutol 750 mg/day with concurrent administration of isoniazid and pyrazinamide due to suspected tuberculosis. Nucleotide sequencing was consistent with M. heckeshornense, which led to a diagnosis of Pulmonary M. heckeshornense infection. Antimicrobial susceptibility tests demonstrated susceptibility to rifampicin, ethambutol and clarithromycin. Therefore, the antimicrobial therapy was switched to rifampicin 450 mg/day, ethambutol 750 mg/day and clarithromycin 800 mg/day. Subsequently, radiographic findings showed transient improvement for about two years. Thereafter, the nodule with a cavity and surrounding infiltrative shadow gradually worsened, which showed that the strain became resistant to the rifampicin, ethambutol and clarithromycin. The woman was hospitalised and underwent right upper lobectomy by video-assisted thoracoscopic surgery two years after the first admission, in 2014. She also completed a 12-month course of rifampicin, ethambutol and clarithromycin after lobectomy, which did not show relapse during the follow- up, and sputum culture was negative for mycobacterium throughout the clinical course. Author comment: "Although her radiographic findings transiently improved, the nodule with a cavity and surrounding infiltrative shadow gradually worsened, which indicated that the strain had become resistant to the antimicrobials." Kurosaki F, et al. Pulmonary Mycobacterium heckeshornense infection in a healthy woman. Journal of Infection and Chemotherapy 24: 483-486, No. 6, Jun 2018. Available from: URL: http://doi.org/10.1016/j.jiac.2018.01.006 - Japan 803323925 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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