{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:27:59Z","timestamp":1785407279630,"version":"3.56.0"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      The\n                      <jats:italic toggle=\"yes\">Mycobacterium abscessus<\/jats:italic>\n                      complex (MABC) is highly resistant to antibiotics, making the pulmonary disease it causes, known as MABC-PD, difficult to treat. Macrolide antibiotics are the main treatment for MABC-PD, but there is ongoing debate about whether to favor azithromycin (AZI) or clarithromycin (CLA). We compared how well AZI and CLA work against MABC and monitored the risk of developing resistance. MABC-PD patients were enrolled, and their primary isolates were collected. The minimum inhibitory concentrations (MICs) of CLA and AZI against these isolates over various incubation times were determined. The incidences of the acquired and inducible resistance of the isolates to both antibiotics were compared, and their association with culture conversion was monitored. The transcription levels of the\n                      <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                      (41) gene were quantified. A total of 61 MABC-PD patients who underwent a macrolide-containing treatment regimen were enrolled. The MICs of AZI against the MABC clinical isolates were found to be approximately four to eight times higher than those of CLA. Inducible macrolide resistance was observed in the subspecies\n                      <jats:italic toggle=\"yes\">Mycobacterium abscessus<\/jats:italic>\n                      , which possessed the functional\n                      <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                      (41) gene. Inducible resistance to AZI happened more rapidly than to CLA, and the transcription of the\n                      <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                      (41) elevated significantly after prolonged exposure to macrolides. Patients infected with isolates with functional\n                      <jats:italic toggle=\"yes\">erm(41<\/jats:italic>\n                      ) gene or\n                      <jats:italic toggle=\"yes\">rrl<\/jats:italic>\n                      mutation experienced lower rates of culture conversion compared to those without such mutations. Acquired and inducible resistance to macrolides significantly contributes to the treatment failures of MABC-PD. The\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      sensitivity and the inducible resistance occurrence all favor CLA over AZI for MABC-PD treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      The\n                      <jats:italic toggle=\"yes\">Mycobacterium abscessus<\/jats:italic>\n                      complex (MABC) is highly resistant to antibiotics, making\n                      <jats:italic toggle=\"yes\">Mycobacterial abscessus<\/jats:italic>\n                      pulmonary disease (MAPD) difficult to treat. Macrolide antibiotics are the main treatment, but there is debate over whether azithromycin (AZI) or clarithromycin (CLA) is more effective. In our study of 61 MAPD patients, we compared the effectiveness of AZI and CLA while tracking resistance. We found that the minimum inhibitory concentrations (MICs) of AZI were four to eight times higher than those of CLA. Isolates with the functional\n                      <jats:italic toggle=\"yes\">erm<\/jats:italic>\n                      (41) gene exhibited macrolide resistance, with AZI developing resistance faster than CLA. Patients with these resistant strains had lower rates of successful treatment. Overall, the\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      sensitivity and the inducible resistance occurrence all favor CLA over AZI for MABC-PD treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01274-25","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:00:44Z","timestamp":1756818044000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Culture conversion and macrolide resistance in\n                    <i>Mycobacterium abscessus<\/i>\n                    complex pulmonary disease"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2800-1983","authenticated-orcid":true,"given":"Suting","family":"Chen","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/013xs5b60","id-type":"ROR","asserted-by":"publisher"}],"name":"Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, affiliated Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengjuan","family":"Bao","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/013xs5b60","id-type":"ROR","asserted-by":"publisher"}],"name":"Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, National Clinical Laboratory on Tuberculosis, Beijing Chest Hospital, affiliated Capital Medical University, Beijing Tuberculosis and Thoracic Tumor 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