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 >or=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 >or=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 >or=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.

[1]  S. Swensen,et al.  Computed tomographic diagnosis of Mycobacterium avium-intracellulare complex in patients with bronchiectasis. , 1994, Chest.

[2]  R. Wallace,,et al.  Randomly amplified polymorphic DNA PCR for comparison of Mycobacterium abscessus strains from nosocomial outbreaks , 1997, Journal of clinical microbiology.

[3]  R. Wallace,,et al.  Azithromycin-containing regimens for treatment of Mycobacterium avium complex lung disease. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  M. Yakrus,et al.  Characterization of isolates of Mycobacterium avium serotypes 4 and 8 from patients with AIDS by multilocus enzyme electrophoresis , 1992, Journal of clinical microbiology.

[5]  M. Picardeau,et al.  Use of different molecular typing techniques for bacteriological follow-up in a clinical trial with AIDS patients with Mycobacterium avium bacteremia , 1997, Journal of clinical microbiology.

[6]  D H Persing,et al.  Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing , 1995, Journal of clinical microbiology.

[7]  R. Wallace,,et al.  Initial clarithromycin monotherapy for Mycobacterium avium-intracellulare complex lung disease. , 1994, American journal of respiratory and critical care medicine.

[8]  R. Mäntyjärvi,et al.  Random amplified polymorphic DNA genotyping of Mycobacterium malmoense , 1994, Journal of clinical microbiology.

[9]  R. Wallace,,et al.  Large DNA restriction fragment polymorphism in the Mycobacterium avium-M. intracellulare complex: a potential epidemiologic tool , 1993, Journal of clinical microbiology.

[10]  R. Wallace,,et al.  Initial (6-month) results of three-times-weekly azithromycin in treatment regimens for Mycobacterium avium complex lung disease in human immunodeficiency virus-negative patients. , 1998, The Journal of infectious diseases.

[11]  R. Wallace,,et al.  Activities of clarithromycin against eight slowly growing species of nontuberculous mycobacteria, determined by using a broth microdilution MIC system , 1992, Antimicrobial Agents and Chemotherapy.

[12]  Nalin Rastogi,et al.  IS1245 Restriction Fragment Length Polymorphism Typing of Mycobacterium avium Isolates: Proposal for Standardization , 1998, Journal of Clinical Microbiology.

[13]  P. Tassios,et al.  Rapid discrimination of Mycobacterium avium strains from AIDS patients by randomly amplified polymorphic DNA analysis , 1997, Journal of clinical microbiology.

[14]  Frank,et al.  Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis , 1993, Journal of clinical microbiology.

[15]  R. Wallace,,et al.  Clarithromycin regimens for pulmonary Mycobacterium avium complex. The first 50 patients. , 1996, American journal of respiratory and critical care medicine.

[16]  Yansheng Zhang,et al.  DNA polymorphisms in strains of Mycobacterium tuberculosis analyzed by pulsed-field gel electrophoresis: a tool for epidemiology , 1992, Journal of clinical microbiology.

[17]  R. Wallace,,et al.  Polyclonal Mycobacterium avium complex infections in patients with nodular bronchiectasis. , 1998, American journal of respiratory and critical care medicine.

[18]  R. Wallace,,et al.  Azithromycin activity against Mycobacterium avium complex lung disease in patients who were not infected with human immunodeficiency virus. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  C. McCarthy,et al.  Multilocus enzyme electrophoresis analysis of the Mycobacterium avium complex and other mycobacteria , 1991, Journal of clinical microbiology.

[20]  R. Johnson,et al.  Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern. The Lady Windermere syndrome. , 1992, Chest.