Successful treatment of macrolide-resistant Mycobacterium abscessus infection using multi-drug regimens including dual β-lactams and phage therapy: case reports in two children

June 12, 2025
Case Report
Masako Shimamura, Bradford Becken, Jessica Tansmore, Madison Cristinziano, Lawrence Abad, Rebekah M Dedrick, Deborah Jacobs-Sera, Graham F Hatfull, Robert A Bonomo, Khalid M Dousa
Pathogen:Mycobacterium abscessus
Infection Type:Pulmonary infection and Disseminated infection
Pathogen Type:Bacteria

Summary

Two children with macrolide-resistant Mycobacterium abscessus infections, a challenging and often refractory condition, were successfully treated. The first case involved a cystic fibrosis patient with chronic pulmonary infection, and the second, a child with disseminated infection post-transplant. Diagnosis was confirmed through culture and molecular methods, revealing macrolide resistance. Both patients received multi-drug regimens, notably including dual β-lactams and adjunctive phage therapy, which led to significant clinical improvement and microbiological clearance. This innovative approach highlights the potential for combination therapies, including bacteriophages, in managing highly resistant and difficult-to-treat NTM infections in pediatric populations.

Key note: Novel multi-drug regimens, including dual β-lactams and phage therapy, can effectively treat macrolide-resistant Mycobacterium abscessus infections.

DOI: 10.1128/asmcr.00087-24