What are the British Thoracic Society Guidelines on drug susceptibility testing and reporting for mycobacterium chelonae infection?

Updated: Dec 20, 2018
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Drug susceptibility testing and reporting should follow the Clinical Laboratory Standards Institute (CLSI) guidelines.

For M avium complex (MAC), clarithromycin and amikacin susceptibility testing should be performed on an isolate taken before initiation of treatment and on subsequent isolates if the patient fails to respond to treatment or recultures MAC after culture conversion.

Macrolide-resistant MAC isolates should be tested against a wider panel of antibiotics to guide, but not dictate, treatment regimens.

For M kansasii, rifampicin susceptibility testing should be performed on an isolate prior to initiation of treatment and on subsequent isolates if the patient fails to respond to treatment or recultures M kansasii after culture conversion.

Rifampicin-resistant M kansasii isolates should be tested against a wider panel of antibiotics to guide, but not dictate, treatment regimens.

Susceptibility testing for M abscessus should include at least clarithromycin, cefoxitin, and amikacin (and preferably also tigecycline, imipenem, minocycline, doxycycline, moxifloxacin, linezolid, co-trimoxazole, and clofazimine if a validated method is available) to guide, but not dictate, treatment regimens.

A minimum of 2 sputum samples collected on separate days should be sent for mycobacterial culture when investigating an individual suspected of having NTM pulmonary disease.

Individuals suspected of having NTM pulmonary disease whose sputum samples are consistently culture-negative for mycobacteria should have CT-directed bronchial washings sent for mycobacterial culture.

Individuals suspected of having NTM pulmonary disease who are unable to expectorate sputum should have CT-directed bronchial washings sent for mycobacterial culture.

Transbronchial biopsies should not be performed routinely in individuals suspected of having NTM pulmonary disease.


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