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The synergetic effect of Imipenem-clarithromycin combination in the Mycobacteroides abscessus complex

  • Takei, Satomi1
  • Ihara, Hiroaki2, 3
  • Togo, Shinsaku2, 1
  • Nakamura, Ayako4
  • Fujimoto, Yuichi2
  • Watanabe, Junko2
  • Kurokawa, Kana2
  • Shibayama, Kohei2
  • Sumiyoshi, Issei2
  • Ochi, Yusuke2
  • Iwai, Moe2, 1
  • Okabe, Takahiro1
  • Chonan, Masayoshi1
  • Misawa, Shigeki1
  • Ohsaka, Akimichi1
  • Takahashi, Kazuhisa2
  • 1 Juntendo University, Faculty of Medicine & Graduate School of Medicine, Tokyo, Japan , Tokyo (Japan)
  • 2 Juntendo University, Faculty of Medicine & Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan , Tokyo (Japan)
  • 3 Koto Hospital, Tokyo, Japan , Tokyo (Japan)
  • 4 Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan , Tokyo (Japan)
Published Article
BMC Microbiology
Springer (Biomed Central Ltd.)
Publication Date
Oct 19, 2020
DOI: 10.1186/s12866-020-02000-5
Springer Nature


BackgroundNontuberculous mycobacteria (NTM) are ubiquitous organisms and the incidence of NTM infections has been increasing in recent years. Mycobacteroides abscessus (M. abscessus) is one of the most antimicrobial-resistant NTM; however, no reliable antibiotic regimen can be officially advocated. We evaluated the efficacy of clarithromycin in combination with various antimicrobial agents against the M. abscessus complex.ResultsTwenty-nine clinical strains of M. abscessus were isolated from various clinical samples. Of the isolates, 10 (34.5%) were of M. abscessus subsp. abscessus, 18 (62.1%) of M. abscessus subsp. massiliense, and 1 (3.4%) of M. abscessus subsp. bolletii. MICs of three antimicrobial agents (amikacin, imipenem, and moxifloxacin) were measured with or without clarithromycin. The imipenem-clarithromycin combination significantly reduced MICs compared to clarithromycin and imipenem monotherapies, including against resistant strains. The association between susceptibility of the M. abscessus complex and each combination of agents was significant (p = 0.001). Adjusted residuals indicated that the imipenem-clarithromycin combination had the synergistic effect (adjusted residual = 3.1) and suppressed the antagonistic effect (adjusted residual = − 3.1). In subspecies of M. abscessus complex, the association with susceptibility of M. abscessus subsp. massiliense was similarly statistically significant (p = 0.036: adjusted residuals of synergistic and antagonistic effect respectively: 2.6 and − 2.6). The association with susceptibility of M. abscessus subsp. abscessus also showed a similar trend but did not reach statistical significance.ConclusionOur data suggest that the imipenem-clarithromycin combination could be the recommended therapeutic choice for the treatment of M. abscessus complex owing to its ability to restore antimicrobial susceptibility.

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