Ann Clin Microbiol.  2016 Sep;19(3):77-81. 10.5145/ACM.2016.19.3.77.

Rapid Diagnosis of Mycobacterium abscessus Bacteremia Using Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry

• Won EJ
• Choi YJ
• Kim SH
• Shin JH

• KMID: 2353044
• DOI: http://doi.org/10.5145/ACM.2016.19.3.77

Abstract

Mycobacterium abscessus was isolated from cultures of seven blood samples from a 64-year-old diabetic female who was admitted due to steroid-unresponsive 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 hybridizationbased assay (Genotype Mycobacterium CM/AS 12, Hain Lifescience) and direct sequencing of a heatshock 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.

Keyword

Bacteremia; MALDI-TOF; Mycobacterium Abscessus

MeSH Terms

Adrenal Insufficiency
Amikacin
Bacteremia*
Catheters
Cefoxitin
Central Venous Catheters
Clarithromycin
Delivery of Health Care
Diagnosis*
Female
Humans
Imipenem
Mass Spectrometry*
Middle Aged
Mycobacterium*
Amikacin
Cefoxitin
Clarithromycin
Imipenem

Figure

• 

  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.

• 

  Fig. 2. (A) Macroscopic and microscopic appearance of the isolate. Growth on sheep blood agar as non-hemolytic, white pinpoint colonies after 72 h of incubation at 35oC in an aerobic environment. (B) The isolates yielded positive results of acid-fast staining (×1,000).

• 

  Fig. 3. Phylogenic trees of hsp65 sequences of the six isolates (B34610_ HSP, B34678_HSP, B34116_HSP, B34611_HSP, B34123_HSP, B34677_ HSP) obtained from the patient in this study.

Reference

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