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Abstract
Mycobacterium abscessus was isolated from cultures of seven blood samples from a 64-year-old diabetic female who was admitted due to steroid-unrespon-sive adrenal insufficiency. The isolates were difficult to identify using the conventional commercial systems, VITEK 2 (bioMérieux, France) or MicroScan (Siemens Healthcare Diagnostics, USA), but were rapidly identified as M. abscessus by a matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based Bruker Biotyper system (Bruker Daltonics, USA). Identification of M. abscessus was confirmed by a reverse hybridization-based assay (Genotype Mycobacterium CM/AS 12, Hain Lifescience) and direct sequencing of a heat-shock protein gene. After removal of her central venous catheter, the patient was successfully treated with a combination therapy comprising clarithromycin, amikacin, cefoxitin, and imipenem. Our findings demonstrate that MALDI-TOF MS can facilitate rapid and accurate identification of M. abscessus from blood cultures, which enables prompt administration of appropriate therapy following catheter removal.
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Fig. 1.
Hospital course of patient with Mycobacterium abscessus bacteremia. Solid lines with diamonds indicate body temperature, and dotted lines with circles indicate the period of antimicrobial agent usage. Empty boxes denote negative cultures, and gray-shaded boxes denote positive cultures. Abbreviations: CVC, peripheral central venous catheter; B, peripheral blood culture; BC, catheter blood culture; T, catheter tip culture. Numbers in boxed indicate number of cultures performed on that day.
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