{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:09:42Z","timestamp":1785424182452,"version":"3.56.0"},"reference-count":32,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["107-2314-B-182A-131-MY3, 109-2813-C-182A-001-B, 113-2314-B-182A-060"],"award-info":[{"award-number":["107-2314-B-182A-131-MY3, 109-2813-C-182A-001-B, 113-2314-B-182A-060"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Foundation in Memory of Dr. Der-Ling Cheng"},{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation","doi-asserted-by":"publisher","award":["CMRPG3M1961"],"award-info":[{"award-number":["CMRPG3M1961"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Mycobacterium avium<\/jats:italic>\n                      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 (\n                      <jats:italic toggle=\"yes\">hsp65<\/jats:italic>\n                      ), internal transcribed spacer, and beta subunit of RNA polymerase (\n                      <jats:italic toggle=\"yes\">rpoB<\/jats:italic>\n                      ) gene sequencing and phylogenetic analyses. Antimicrobial susceptibility testing (AST) was performed with 13 antimicrobial agents. The predominant pathogen identified was\n                      <jats:italic toggle=\"yes\">Mycobacterium intracellulare<\/jats:italic>\n                      clade A (122\/294, 41.5%), followed by\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      subsp.\n                      <jats:italic toggle=\"yes\">chimaera<\/jats:italic>\n                      (87\/294, 29.6%),\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      subsp.\n                      <jats:italic toggle=\"yes\">intracellulare<\/jats:italic>\n                      (39\/294, 13.3%),\n                      <jats:italic toggle=\"yes\">M. avium<\/jats:italic>\n                      (35\/294, 11.9%), and four other species (11\/294, 3.7%). AST showed that clarithromycin and amikacin had high susceptibility rates against\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      clade A,\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      subsp.\n                      <jats:italic toggle=\"yes\">chimaera<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      subsp.\n                      <jats:italic toggle=\"yes\">intracellulare,<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">M. avium<\/jats:italic>\n                      , 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\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      might exist in MAC pulmonary infections in Taiwan. Among MAC species,\n                      <jats:italic toggle=\"yes\">M. avium<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        There are more than 10 (sub)species within the\n                        <jats:italic toggle=\"yes\">Mycobacterium avium<\/jats:italic>\n                        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\n                        <jats:italic toggle=\"yes\">Mycobacterium avium<\/jats:italic>\n                        pulmonary infections compared to other species causing pulmonary infections. Individualized anti-mycobacterial therapy should focus on each species responsible for pulmonary disease.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00309-25","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:00:16Z","timestamp":1751875216000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Heterogeneity among\n                    <i>Mycobacterium avium<\/i>\n                    complex species isolated from pulmonary infection in Taiwan"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6544-4417","authenticated-orcid":true,"given":"Hsiu-Mei","family":"Lin","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02dnn6q67","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Family Medicine, Linkou Chang Gung Memorial 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