Lack of Antimicrobial Bactericidal Activity in Mycobacterium abscessus

Abstract

ABSTRACTAntibiotic therapy of infections caused by the emerging pathogenMycobacterium abscessusis challenging due to the organism's natural resistance toward most clinically available antimicrobials. We investigated the bactericidal activity of antibiotics commonly administered inM. abscessusinfections in order to better understand the poor therapeutic outcome. Time-kill curves were generated for clinicalM. abscessusisolates,Mycobacterium smegmatis, andEscherichia coliby using antibiotics commonly categorized as bactericidal (amikacin and moxifloxacin) or bacteriostatic (tigecycline and linezolid). In addition, the impact of aminoglycoside-modifying enzymes on the mode of action of substrate and nonsubstrate aminoglycosides was studied by usingM. smegmatisas a model organism. While amikacin and moxifloxacin were bactericidal againstE. coli, none of the tested compounds showed bactericidal activity againstM. abscessus. Further mechanistic investigations of the mode of action of aminoglycosides inM. smegmatisrevealed that the bactericidal activity of tobramycin and gentamicin was restored by disruption of the chromosomalaac(2′) gene in the mycobacterial genome. The lack of bactericidal antibiotics in currently recommended treatment regimens provides a reasonable explanation for the poor therapeutic outcome inM. abscessusinfection. Our findings suggest that chromosomally encoded drug-modifying enzymes play an important role in the lack of aminoglycoside bactericidal activity against rapidly growing mycobacteria.