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Susceptibility testing of Mycobacterium avium complex isolates

Mycobacterium avium complex (MAC) includes M. avium and M. intracellulare (MAI), and they are the most frequent isolates among the nontuberculous mycobacteria found in specimens taken from patients. It is ubiquitous in the environment (22, 31, 103, 104), and water aerosols have been suggested as the most likely transmission route (22, 31, 32, 87). As identified by their serovars, the proportion ofM. avium andM. intracellulare isolates in patients reflects the distribution of these species in the environments of different geographic areas (22, 25, 85, 87, 107). Infections caused by these organisms are not transmissible from person to person (53, 62). Prior to the emergence of the AIDS epidemic, MAC infections most often manifested in humans as a localized pulmonary disease which in the United States occurred in 2,000 to 3,000 patients annually (27, 62, 86, 103, 109, 111). Most noticeable among other localized manifestations was cervical lymphadenopathy in children (29, 76, 86, 89, 96, 99). Clinical features of pulmonary MAC disease were described in a number of reports emphasizing that in most of the patients this disease developed on the background of an underlying chronic pulmonary disease, silicosis, diabetes mellitus, cancer, treatment with corticosteroids, or other conditions that might have affected their immunity (13, 75, 114). The most recent reports suggested that MAC pulmonary disease can occur in persons without identifiable predisposing conditions (61, 90). MAC pulmonary disease appears most often in either multinodular bronchiectasis or cavitary forms (61, 67, 91, 98). The diagnosis in patients with minimal lung damage may represent a challenge since it requires differentiation between invasive disease and simply colonization of mycobacteria in the bronchi, and especially in patients with bronchiectasis, cysts, and posttuberculosis cavities. Therefore, the diagnosis requires repeated isolation of a substantial number of bacteria from sputum along with clinical and radiologic data. Disseminated MAC infections were reported in up to 24% of AIDS patients (54, 56), but its probability can be especially high in those with advanced AIDS, when the CD4 lymphocyte count is less than 100/mm (8, 50, 52, 57, 85). This new MAC epidemic is growing with the increasing number of AIDS patients and their increasing period of survival, most noticeable in industrialized countries. The diagnosis of disseminated MAC infections is based on isolation of mycobacteria from blood or tissue biopsy specimens, along with symptoms attributed to this disease (3, 30, 34, 68, 115, 117). ANTIMICROBIAL THERAPY OF MAC INFECTIONS