{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:01:11Z","timestamp":1790805671586,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82204107"],"award-info":[{"award-number":["82204107"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012165","name":"Key Technologies Research and Development Program","doi-asserted-by":"publisher","award":["2023YFC2307300"],"award-info":[{"award-number":["2023YFC2307300"]}],"id":[{"id":"10.13039\/501100012165","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012165","name":"Key Technologies Research and Development Program","doi-asserted-by":"publisher","award":["2023YFC2307305"],"award-info":[{"award-number":["2023YFC2307305"]}],"id":[{"id":"10.13039\/501100012165","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","award":["20234Y0251"],"award-info":[{"award-number":["20234Y0251"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","award":["GWVI-11\u00b72-YQ06"],"award-info":[{"award-number":["GWVI-11\u00b72-YQ06"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Understanding the clinical implications of minimum inhibitory concentration (MIC) may facilitate optimal drug selection in Mycobacterium avium complex pulmonary disease (MAC-PD) treatment. This study aimed to investigate the association of individual MICs with treatment response of MAC-PD. A retrospective cohort study was conducted in China, including eligible patients diagnosed with MAC-PD between 2018 and 2021. Treatment success rates were calculated across different MIC levels in a subgroup of patients receiving relatively uniform regimens. Associations between MICs and treatment outcomes were investigated by logistic regression analysis. In total, 209 patients with confirmed MAC-PD and initiated treatment were included. The median age was 60.0 years. Among 155 patients who completed treatment, 67.1% achieved treatment success. The treatment success rate was low in patients with clarithromycin MIC \u2265 64 mg\/L (25.0%, 1\/4) or ethambutol MIC &gt; 16 mg\/L (42.9%, 3\/7), while remaining relatively stable (75\u2013100%) at other MIC levels. Univariate analyses showed that clarithromycin and ethambutol MICs above these thresholds were associated with increased risk of treatment failure. Our findings suggest an association between clarithromycin MICs and treatment outcomes in patients with MAC-PD receiving standard guideline-recommended regimens. Meanwhile, elevated ethambutol MICs exhibited potential clinical relevance, warranting further investigation.<\/jats:p>","DOI":"10.3390\/pathogens14121218","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T09:34:37Z","timestamp":1764581677000},"page":"1218","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of Antimicrobial Susceptibility with Treatment Response in Mycobacterium avium complex Pulmonary Disease"],"prefix":"10.3390","volume":"14","author":[{"given":"Xuejiao","family":"Luo","sequence":"first","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-4002","authenticated-orcid":false,"given":"Yuhang","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina Davies","family":"Forsman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Karolinska Institute, 17177 Stockholm, Sweden"},{"name":"Department of Infectious Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"He","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoling","family":"Yang","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Lou","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0035-8220","authenticated-orcid":false,"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Yao","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yidian","family":"Liu","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Bruchfeld","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Karolinska Institute, 17177 Stockholm, Sweden"},{"name":"Department of Infectious Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6703-0288","authenticated-orcid":false,"given":"Jan-Willem","family":"Alffenaar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Westmead Hospital, Syndney, NSW 2145, Australia"},{"name":"The University of Sydney Infectious Diseases Institute (Sydney ID), Sydney, NSW 2145, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8695-7396","authenticated-orcid":false,"given":"Biao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai 200030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xubin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"},{"name":"Division of Infectious Diseases, Department of Medicine, Karolinska Institute, 17177 Stockholm, Sweden"},{"name":"Department of Infectious Diseases, Karolinska University Hospital, 17176 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Sha","sequence":"additional","affiliation":[{"name":"Clinic and Research Centre of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ijid.2022.10.013","article-title":"Global trends of pulmonary infections with nontuberculous mycobacteria: A systematic review","volume":"125","author":"Dahl","year":"2022","journal-title":"Int. J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.ccm.2023.08.012","article-title":"Global Epidemiology of Nontuberculous Mycobacterial Pulmonary Disease: A Review","volume":"44","author":"Prevots","year":"2023","journal-title":"Clin. Chest Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"240058","DOI":"10.1183\/16000617.0058-2024","article-title":"Growing from common ground: Nontuberculous mycobacteria and bronchiectasis","volume":"33","author":"Bosteels","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jinf.2021.05.019","article-title":"Nontuberculous mycobacterial pulmonary disease and associated risk factors in China: A prospective surveillance study","volume":"83","author":"Tan","year":"2021","journal-title":"J. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2000535","DOI":"10.1183\/13993003.00535-2020","article-title":"Treatment of nontuberculous mycobacterial pulmonary disease: An official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline","volume":"56","author":"Daley","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_6","first-page":"918","article-title":"[Guidelines for the diagnosis and treatment of nontuberculous mycobacterial disease (2020)]","volume":"43","author":"Association","year":"2020","journal-title":"Chin. J. Tuberc. Respir. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2017-210927","article-title":"British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)","volume":"72","author":"Haworth","year":"2017","journal-title":"Thorax"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.chest.2018.01.024","article-title":"Microbiologic Outcome of Interventions Against Mycobacterium avium Complex Pulmonary Disease: A Systematic Review","volume":"153","author":"Diel","year":"2018","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/cid\/cix517","article-title":"Treatment Outcomes of Mycobacterium avium Complex Lung Disease: A Systematic Review and Meta-analysis","volume":"65","author":"Kwak","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1080\/14787210.2020.1720650","article-title":"Antibiotic therapy success rate in pulmonary Mycobacterium avium complex: A systematic review and meta-analysis","volume":"18","author":"Nasiri","year":"2020","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_11","unstructured":"CLSI (2023). Performance Standards for Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomyces, Clinical and Laboratory Standards Institute. [2nd ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.cmi.2023.02.007","article-title":"Towards clinical breakpoints for non-tuberculous mycobacteria-Determination of epidemiological cut off values for the Mycobacterium avium complex and Mycobacterium abscessus using broth microdilution","volume":"29","author":"Froberg","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s10156-011-0351-x","article-title":"Relationship between clinical efficacy for pulmonary MAC and drug-sensitivity test for isolated MAC in a recent 6-year period","volume":"18","author":"Kobashi","year":"2012","journal-title":"J. Infect. Chemother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s10156-006-0457-8","article-title":"Relationship between clinical efficacy of treatment of pulmonary Mycobacterium avium complex disease and drug-sensitivity testing of Mycobacterium avium complex isolates","volume":"12","author":"Kobashi","year":"2006","journal-title":"J. Infect. Chemother."},{"key":"ref_15","unstructured":"Research Committee of the British Thoracic Society (2002). Pulmonary disease caused by Mycobacterium avium-intracellulare in HIV-negative patients: Five-year follow-up of patients receiving standardised treatment. Int. J. Tuberc. Lung Dis., 6, 628\u2013634."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e0008424","DOI":"10.1128\/aac.00084-24","article-title":"Phenotypic amikacin resistance may not indicate poor response to amikacin in Mycobacterium avium complex pulmonary disease","volume":"68","author":"Minuk","year":"2024","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3389","DOI":"10.1128\/JCM.01612-13","article-title":"In vitro activity of amikacin against isolates of Mycobacterium avium complex with proposed MIC breakpoints and finding of a 16S rRNA gene mutation in treated isolates","volume":"51","author":"Iakhiaeva","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1164\/rccm.201204-0682OC","article-title":"The pharmacokinetics and pharmacodynamics of pulmonary Mycobacterium avium complex disease treatment","volume":"186","author":"Egelund","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ijid.2016.12.027","article-title":"Minimum inhibitory concentration distributions for Mycobacterium avium complex-towards evidence-based susceptibility breakpoints","volume":"55","author":"Schon","year":"2017","journal-title":"Int. J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kahlmeter, G., and Turnidge, J. (2023). Wild-type distributions of minimum inhibitory concentrations and epidemiological cut-off values-laboratory and clinical utility. Clin. Microbiol. Rev., 36.","DOI":"10.1128\/cmr.00100-22"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/jac\/dkv309","article-title":"Relative contribution of biological variation and technical variables to zone diameter variations of disc diffusion susceptibility testing","volume":"71","author":"Hombach","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.diagmicrobio.2005.03.012","article-title":"The effect of interlaboratory variability on antimicrobial susceptibility determination","volume":"53","author":"Annis","year":"2005","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1093\/cid\/ciae546","article-title":"Relationship Between Clarithromycin Minimum Inhibitory Concentrations and Treatment Responses in Mycobacterium avium Complex Pulmonary Disease","volume":"80","author":"Kim","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e01096-18","DOI":"10.1128\/JCM.01096-18","article-title":"Rapid Identification of Clinically Relevant Mycobacterium Species by Multicolor Melting Curve Analysis","volume":"57","author":"Xu","year":"2019","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","unstructured":"(2025, October 06). Thermo Scientific Sensititre Plate Guide for Antimicrobial Susceptibility Testing. Available online: https:\/\/www.thermofisher.com\/order\/catalog\/product\/SLOMYCOI."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1800170","DOI":"10.1183\/13993003.00170-2018","article-title":"Treatment outcome definitions in nontuberculous mycobacterial pulmonary disease: An NTM-NET consensus statement","volume":"51","author":"Aksamit","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1164\/rccm.200604-571ST","article-title":"An official ATS\/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases","volume":"175","author":"Griffith","year":"2007","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s40262-021-01000-6","article-title":"Therapeutic Drug Monitoring in Non-Tuberculosis Mycobacteria Infections","volume":"60","author":"Alffenaar","year":"2021","journal-title":"Clin. Pharmacokinet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ijantimicag.2013.03.010","article-title":"Synergistic activity of rifampicin and ethambutol against slow-growing nontuberculous mycobacteria is currently of questionable clinical significance","volume":"42","author":"Hoefsloot","year":"2013","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3878","DOI":"10.1128\/AAC.00099-10","article-title":"Pharmacokinetics of rifampin and clarithromycin in patients treated for Mycobacterium ulcerans infection","volume":"54","author":"Alffenaar","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e00491-18","DOI":"10.1128\/AAC.00491-18","article-title":"In Vitro MIC Values of Rifampin and Ethambutol and Treatment Outcome in Mycobacterium avium Complex Lung Disease","volume":"62","author":"Kwon","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e0087423","DOI":"10.1128\/aac.00874-23","article-title":"The role of rifampicin within the treatment of Mycobacterium avium pulmonary disease","volume":"67","author":"Schildkraut","year":"2023","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1164\/rccm.200603-450OC","article-title":"Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease","volume":"174","author":"Griffith","year":"2006","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1164\/rccm.200204-363OC","article-title":"Lung deposition and efficiency of nebulized amikacin during Escherichia coli pneumonia in ventilated piglets","volume":"166","author":"Goldstein","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.chest.2023.11.038","article-title":"Safety and Efficacy of Clofazimine as an Alternative for Rifampicin in Mycobacterium avium Complex Pulmonary Disease Treatment: Outcomes of a Randomized Trial","volume":"165","author":"Zweijpfenning","year":"2024","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kim, D.H., Kim, B.G., Kim, S.Y., Huh, H.J., Lee, N.Y., Koh, W.J., Kim, H., Kwon, O.J., and Jhun, B.W. (2021). In Vitro Activity and Clinical Outcomes of Clofazimine for Nontuberculous Mycobacteria Pulmonary Disease. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194581"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.ijantimicag.2010.12.014","article-title":"Comparative in vitro and in vivo antimicrobial activities of sitafloxacin, gatifloxacin and moxifloxacin against Mycobacterium avium","volume":"37","author":"Sano","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"i20","DOI":"10.1093\/jac\/dkx303","article-title":"Failure of the azithromycin and ethambutol combination regimen in the hollow-fibre system model of pulmonary Mycobacterium avium infection is due to acquired resistance","volume":"72","author":"Srivastava","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/jac\/dkx427","article-title":"MIC-based dose adjustment: Facts and fables","volume":"73","author":"Mouton","year":"2018","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/12\/1218\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T05:12:49Z","timestamp":1764652369000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/12\/1218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,29]]},"references-count":39,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["pathogens14121218"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14121218","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,29]]}}}