Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan
ABSTRACT Mycobacterium avium complex (MAC) is an emerging pathogen causing nontuberculous pulmonary infections globally. However, clinical treatment guidelines regard MAC as a single entity, recommending a universal anti-mycobacterial combination therapy. Our study aimed to distinguish species among...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
American Society for Microbiology
2025-08-01
|
| Series: | Microbiology Spectrum |
| Subjects: | |
| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.00309-25 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849395899739930624 |
|---|---|
| author | Hsiu-Mei Lin Chin-Chung Shu Chun-Hao Chen Nan-Yu Chen Jeng-How Yang Chih-Hung Chen Shih-Hong Li Chih-Liang Wang Chih-Teng Yu Shu-Min Lin Kuo-Chin Kao Chung-Chi Huang Cheng-Ta Yang Jang-Jih Lu Cheng-Hsun Chiu Hsin-Chih Lai Ting-Shu Wu |
| author_facet | Hsiu-Mei Lin Chin-Chung Shu Chun-Hao Chen Nan-Yu Chen Jeng-How Yang Chih-Hung Chen Shih-Hong Li Chih-Liang Wang Chih-Teng Yu Shu-Min Lin Kuo-Chin Kao Chung-Chi Huang Cheng-Ta Yang Jang-Jih Lu Cheng-Hsun Chiu Hsin-Chih Lai Ting-Shu Wu |
| author_sort | Hsiu-Mei Lin |
| collection | DOAJ |
| description | ABSTRACT Mycobacterium avium complex (MAC) is an emerging pathogen causing nontuberculous pulmonary infections globally. However, clinical treatment guidelines regard MAC as a single entity, recommending a universal anti-mycobacterial combination therapy. Our study aimed to distinguish species among MAC and investigate the antimicrobial susceptibility for the selection of optimal antimicrobial agents in Taiwan. Two hundred ninety-four consecutive sputum samples confirmed as MAC by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry were collected from 1 November 2015 to 31 August 2020 at Linkou Chang Gung Memorial Hospital in Taiwan. These isolates were identified through 16S rRNA gene, 23S rRNA gene, heat-shock protein 65 gene (hsp65), internal transcribed spacer, and beta subunit of RNA polymerase (rpoB) gene sequencing and phylogenetic analyses. Antimicrobial susceptibility testing (AST) was performed with 13 antimicrobial agents. The predominant pathogen identified was Mycobacterium intracellulare clade A (122/294, 41.5%), followed by M. intracellulare subsp. chimaera (87/294, 29.6%), M. intracellulare subsp. intracellulare (39/294, 13.3%), M. avium (35/294, 11.9%), and four other species (11/294, 3.7%). AST showed that clarithromycin and amikacin had high susceptibility rates against M. intracellulare clade A, M. intracellulare subsp. chimaera, M. intracellulare subsp. intracellulare, and M. avium, while linezolid and moxifloxacin exhibited higher resistance. The comparison of minimum inhibitory concentrations among species within the same antimicrobial agent showed variability in susceptibility. A diverse clonality of M. intracellulare might exist in MAC pulmonary infections in Taiwan. Among MAC species, M. avium exhibited multidrug resistance. Although international guidelines recommend macrolide, ethambutol, and rifampin for treating MAC pulmonary disease, our study highlights the importance of considering species identification and regional AST results when selecting anti-mycobacterial agents.IMPORTANCEThere are more than 10 (sub)species within the Mycobacterium avium complex. According to modern biotechnology, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, it is still difficult to differentiate the complex into specific species precisely. We utilize concatenated multi-gene sequencing to classify this complex at the (sub)species level. Indeed, we encountered poorer treatment outcomes when facing Mycobacterium avium pulmonary infections compared to other species causing pulmonary infections. Individualized anti-mycobacterial therapy should focus on each species responsible for pulmonary disease. |
| format | Article |
| id | doaj-art-ea905e91ee7942e69cba5f69da76dadd |
| institution | Kabale University |
| issn | 2165-0497 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | American Society for Microbiology |
| record_format | Article |
| series | Microbiology Spectrum |
| spelling | doaj-art-ea905e91ee7942e69cba5f69da76dadd2025-08-20T03:39:28ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972025-08-0113810.1128/spectrum.00309-25Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in TaiwanHsiu-Mei Lin0Chin-Chung Shu1Chun-Hao Chen2Nan-Yu Chen3Jeng-How Yang4Chih-Hung Chen5Shih-Hong Li6Chih-Liang Wang7Chih-Teng Yu8Shu-Min Lin9Kuo-Chin Kao10Chung-Chi Huang11Cheng-Ta Yang12Jang-Jih Lu13Cheng-Hsun Chiu14Hsin-Chih Lai15Ting-Shu Wu16Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, National Taiwan University School of Medicine, , Taipei, TaiwanDepartment of Orthopedics, Chiayi Chang Gung Memorial Hospital, , Chiayi, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Thoracic Medicine, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Thoracic Medicine, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Thoracic Medicine, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Clinical Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, TaiwanSchool of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Medical Technology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanABSTRACT Mycobacterium avium complex (MAC) is an emerging pathogen causing nontuberculous pulmonary infections globally. However, clinical treatment guidelines regard MAC as a single entity, recommending a universal anti-mycobacterial combination therapy. Our study aimed to distinguish species among MAC and investigate the antimicrobial susceptibility for the selection of optimal antimicrobial agents in Taiwan. Two hundred ninety-four consecutive sputum samples confirmed as MAC by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry were collected from 1 November 2015 to 31 August 2020 at Linkou Chang Gung Memorial Hospital in Taiwan. These isolates were identified through 16S rRNA gene, 23S rRNA gene, heat-shock protein 65 gene (hsp65), internal transcribed spacer, and beta subunit of RNA polymerase (rpoB) gene sequencing and phylogenetic analyses. Antimicrobial susceptibility testing (AST) was performed with 13 antimicrobial agents. The predominant pathogen identified was Mycobacterium intracellulare clade A (122/294, 41.5%), followed by M. intracellulare subsp. chimaera (87/294, 29.6%), M. intracellulare subsp. intracellulare (39/294, 13.3%), M. avium (35/294, 11.9%), and four other species (11/294, 3.7%). AST showed that clarithromycin and amikacin had high susceptibility rates against M. intracellulare clade A, M. intracellulare subsp. chimaera, M. intracellulare subsp. intracellulare, and M. avium, while linezolid and moxifloxacin exhibited higher resistance. The comparison of minimum inhibitory concentrations among species within the same antimicrobial agent showed variability in susceptibility. A diverse clonality of M. intracellulare might exist in MAC pulmonary infections in Taiwan. Among MAC species, M. avium exhibited multidrug resistance. Although international guidelines recommend macrolide, ethambutol, and rifampin for treating MAC pulmonary disease, our study highlights the importance of considering species identification and regional AST results when selecting anti-mycobacterial agents.IMPORTANCEThere are more than 10 (sub)species within the Mycobacterium avium complex. According to modern biotechnology, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, it is still difficult to differentiate the complex into specific species precisely. We utilize concatenated multi-gene sequencing to classify this complex at the (sub)species level. Indeed, we encountered poorer treatment outcomes when facing Mycobacterium avium pulmonary infections compared to other species causing pulmonary infections. Individualized anti-mycobacterial therapy should focus on each species responsible for pulmonary disease.https://journals.asm.org/doi/10.1128/spectrum.00309-25concatenated gene sequencesphylogenetic analysismultidrug resistancegenetic diversitycombination therapy |
| spellingShingle | Hsiu-Mei Lin Chin-Chung Shu Chun-Hao Chen Nan-Yu Chen Jeng-How Yang Chih-Hung Chen Shih-Hong Li Chih-Liang Wang Chih-Teng Yu Shu-Min Lin Kuo-Chin Kao Chung-Chi Huang Cheng-Ta Yang Jang-Jih Lu Cheng-Hsun Chiu Hsin-Chih Lai Ting-Shu Wu Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan Microbiology Spectrum concatenated gene sequences phylogenetic analysis multidrug resistance genetic diversity combination therapy |
| title | Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan |
| title_full | Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan |
| title_fullStr | Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan |
| title_full_unstemmed | Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan |
| title_short | Heterogeneity among Mycobacterium avium complex species isolated from pulmonary infection in Taiwan |
| title_sort | heterogeneity among mycobacterium avium complex species isolated from pulmonary infection in taiwan |
| topic | concatenated gene sequences phylogenetic analysis multidrug resistance genetic diversity combination therapy |
| url | https://journals.asm.org/doi/10.1128/spectrum.00309-25 |
| work_keys_str_mv | AT hsiumeilin heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chinchungshu heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chunhaochen heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT nanyuchen heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT jenghowyang heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chihhungchen heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT shihhongli heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chihliangwang heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chihtengyu heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT shuminlin heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT kuochinkao heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chungchihuang heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chengtayang heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT jangjihlu heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT chenghsunchiu heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT hsinchihlai heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan AT tingshuwu heterogeneityamongmycobacteriumaviumcomplexspeciesisolatedfrompulmonaryinfectionintaiwan |