{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:42:45Z","timestamp":1792590165315,"version":"4.5.0"},"reference-count":33,"publisher":"American Society for Microbiology","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["113-E0007, 114-E0007, 115-E0007"],"award-info":[{"award-number":["113-E0007, 114-E0007, 115-E0007"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Macrolides remained cornerstone of\n                      <jats:italic toggle=\"yes\">Mycobacterium abscessus<\/jats:italic>\n                      treatment, but emerging resistance patterns compromised therapeutic efficacies. Clarithromycin resistance can manifest as either mutational or inducible, while the clinical impacts of different resistance mechanisms in\n                      <jats:italic toggle=\"yes\">M. abscessus<\/jats:italic>\n                      pulmonary disease (MAB-PD) had been poorly characterized. We conducted a multicenter retrospective cohort study from 2011 to 2023 across four tertiary centers in Taiwan. Adults with clarithromycin-resistant MAB-PD were included and stratified by resistance type: mutational vs inducible. Outcomes included all-cause 3-year mortality, microbiological clearance, and radiographic progression. Among 108 enrolled patients, 16 (14.7%) had mutational resistance and the remaining 92 had inducible type. Isolates comprised 103\n                      <jats:italic toggle=\"yes\">M. abscessus<\/jats:italic>\n                      , three\n                      <jats:italic toggle=\"yes\">M. massiliense<\/jats:italic>\n                      , and two\n                      <jats:italic toggle=\"yes\">M. bolletii<\/jats:italic>\n                      . Mutational resistance was associated with significantly higher 3-year mortality (18.8% vs 4.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03) and lower acid-fast smear conversion rates in treated patients (18.2% vs 67.6%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004). Multivariable analysis identified mutational clarithromycin resistance as an independent predictor of mortality (adjusted hazard ratio 5.21, 95% confidence interval 1.10\u201324.6,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04). Strains with mutational resistance demonstrated higher median minimal inhibitory concentrations to linezolid (24 vs 16 mg\/L), cefoxitin (64 vs 32 mg\/L), and amikacin (16 vs 8 mg\/L). Mutational clarithromycin resistance in MAB-PD is associated with substantially worse clinical outcomes compared to inducible resistance, including higher mortality and poorer treatment responses. These findings suggested that more intensive treatment strategies might be needed for mutational clarithromycin resistance in MAB-PD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      Macrolide resistance critically undermines treatment outcomes in\n                      <jats:italic toggle=\"yes\">Mycobacterium abscessus<\/jats:italic>\n                      lung disease, yet the prognostic impact of distinct resistance mechanisms has remained unclear. This multicenter study demonstrates that mutational clarithromycin resistance, although less common than inducible resistance, is associated with markedly higher mortality, poorer microbiological response, and broader multidrug resistance. These findings provide clinically actionable evidence that not all macrolide resistance is equivalent. Recognizing mutational resistance as a high-risk phenotype has important implications for risk stratification, prognostication, and treatment intensification, supporting a more personalized approach to managing MAB-LD in routine clinical practice.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.04232-25","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:03:46Z","timestamp":1792587826000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Impact of different clarithromycin resistance in\n                    <i>Mycobacterium abscessus<\/i>\n                    lung disease: a multicenter cohort study"],"prefix":"10.1128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1069-4558","authenticated-orcid":true,"given":"Ting-Wei","family":"Kao","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/019tq3436","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, Far-Eastern Memorial Hospital","place":["New Taipei City, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Wei","family":"Pan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03ymy8z76","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Chest Medicine, Taipei Veterans General Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Jung","family":"Liu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, National Taiwan University Hospital","place":["Hsin-Chu, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Huai","family":"Wang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/019tq3436","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, Far-Eastern Memorial Hospital","place":["New Taipei City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Ni","family":"Huang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7805-4178","authenticated-orcid":true,"given":"Yu-Tsung","family":"Huang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0311-5148","authenticated-orcid":true,"given":"Chin-Chung","family":"Shu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03nteze27","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/05bqach95","id-type":"ROR","asserted-by":"publisher"}],"name":"Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.4.716-746.2002"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-017-2949-0"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-73607-x"},{"key":"e_1_3_5_5_2","volume-title":"Susceptibility testing of mycobacteria, Nocardiae, and other aerobic actinomycetes","author":"Woods GL","year":"2011","unstructured":"Woods GL, Brown-Elliott BA, Conville PS, Desmond EP, Hall GS, Lin G, Pfyffer GE, Ridderhof JC, Siddiqi SH, Wallace Jr RJ, Warren NG, Witebsky FG. 2011. Susceptibility testing of mycobacteria, Nocardiae, and other aerobic actinomycetes. 2nd ed. Clinical and Laboratory Standards Institute, Wayne (PA).","edition":"2"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00535-2020"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2010.12.012"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw723"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200905-0704OC"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00861-10"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.909274"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02360-17"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01688-08"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1164\/arrd.1971.103.5.625"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13908"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.42.670"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e34546"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-34576-z"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01102-2015"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2023.11.018"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq237"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11050571"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268821002211"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.28625-0"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00986-07"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.aaf8156"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz071"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00454-2020"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-011-9321-4"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2021.106549"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-024-01570-y"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-60132-0"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2024.2361490"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01146-17"}],"container-title":["Microbiology Spectrum"],"original-title":[],"contributor":[{"given":"Byung Woo","family":"Jhun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]},{"given":"Emmanuelle","family":"Cambau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"reviewer"}]}],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.04232-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.04232-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:03:47Z","timestamp":1792587827000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.04232-25"}},"subtitle":[],"editor":[{"given":"Jian","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":33,"alternative-id":["10.1128\/spectrum.04232-25"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.04232-25","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"2025-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e04232-25"}}