Abstract：
OBJECTIVE: Mycobacterium abscessus complex (MABC) infections are increasing worldwide. Furthermore, these infections have a low treatment success rate due to their resistance to many current antibiotics. This study aimed to determine the overall in vitro activity of the tetracyclines doxycycline (DOX), minocycline (MIN), and tigecycline (TGC) against MABC clinical isolates.
METHODS: A systematic review of PubMed/MEDLINE, Web of Science, and Embase was conducted up to August 28, 2023. Studies applying the drug susceptibility testing standards of the Clinical and Laboratory Standards Institute were considered. A random effects model was used to assess the total in vitro resistance rates of the MABC clinical isolates to DOX, MIN, and TGC. The I2 and Cochran\'s Q statistics were employed to evaluate the origins of heterogeneity. All analyses were conducted using CMA V.3 software.
RESULTS: Twenty-six publications (22, 12, and 11 studies on DOX, MIN, and TGC, respectively) were included. The pooled in vitro resistance rates of the MABC clinical isolates to DOX and MIN at the breakpoint of 8 μg/mL were 93.0 % (95 % CI, 89.2 %-95.5 %) and 87.2 % (95 % CI, 76.5 %-93.4 %), respectively. In the case of TGC, the breakpoints of 2, 4, and 8 μg/mL were associated with pooled resistance rates of 2.5 % (95 % CI, 0.5 %-11.6 %), 7.2 % (95 % CI, 4.0 %-12.5 %), and 16.8 % (95 % CI, 4.7 %-45.0 %), respectively.
CONCLUSIONS: Among the three examined tetracyclines, MABC exhibited extremely high resistance rates to DOX and MIN, thereby limiting their use in treating MABC infections. Conversely, MABC showed an increased susceptibility rate to TGC, highlighting TGC administration as a viable treatment option for patients with MABC infections.
METHODS: A systematic review of PubMed/MEDLINE, Web of Science, and Embase was conducted up to August 28, 2023. Studies applying the drug susceptibility testing standards of the Clinical and Laboratory Standards Institute were considered. A random effects model was used to assess the total in vitro resistance rates of the MABC clinical isolates to DOX, MIN, and TGC. The I2 and Cochran\'s Q statistics were employed to evaluate the origins of heterogeneity. All analyses were conducted using CMA V.3 software.
RESULTS: Twenty-six publications (22, 12, and 11 studies on DOX, MIN, and TGC, respectively) were included. The pooled in vitro resistance rates of the MABC clinical isolates to DOX and MIN at the breakpoint of 8 μg/mL were 93.0 % (95 % CI, 89.2 %-95.5 %) and 87.2 % (95 % CI, 76.5 %-93.4 %), respectively. In the case of TGC, the breakpoints of 2, 4, and 8 μg/mL were associated with pooled resistance rates of 2.5 % (95 % CI, 0.5 %-11.6 %), 7.2 % (95 % CI, 4.0 %-12.5 %), and 16.8 % (95 % CI, 4.7 %-45.0 %), respectively.
CONCLUSIONS: Among the three examined tetracyclines, MABC exhibited extremely high resistance rates to DOX and MIN, thereby limiting their use in treating MABC infections. Conversely, MABC showed an increased susceptibility rate to TGC, highlighting TGC administration as a viable treatment option for patients with MABC infections.
摘要：
目的：脓肿分枝杆菌（MABC）感染在全球范围内呈上升趋势。此外，这些感染的治疗成功率较低，因为它们对许多目前的抗生素具有耐药性。本研究旨在确定四环素类多西环素（DOX）的整体体外活性，米诺环素(MIN),和替加环素（TGC）对MABC临床分离株。
方法：对PubMed/MEDLINE，WebofScience,Embase进行到2023年8月28日。考虑了应用临床和实验室标准研究所的药物敏感性测试标准的研究。随机效应模型用于评估MABC临床分离株对DOX的体外总耐药率，MIN,TGC。采用I2和Cochran的Q统计量来评估异质性的起源。所有分析均使用CMAV.3软件进行。
结果：26篇出版物（关于DOX的22、12和11项研究，MIN,TGC,分别)包括在内。在8μg/mL的断点处，MABC临床分离株对DOX和MIN的合并体外耐药率分别为93.0％（95％CI，89.2％-95.5％）和87.2％（95％CI，76.5％-93.4％），分别。在TGC的情况下，2、4和8μg/mL的断点与2.5％的合并耐药率相关（95％CI，0.5％-11.6％），7.2%（95%CI，4.0%-12.5%），和16.8%（95%CI，4.7%-45.0%），分别。
结论：在三种检查的四环素中，MABC对DOX和MIN表现出极高的耐药率，从而限制了它们在治疗MABC感染中的用途。相反，MABC对TGC的敏感性增加，强调TGC作为MABC感染患者的可行治疗选择。
方法：对PubMed/MEDLINE，WebofScience,Embase进行到2023年8月28日。考虑了应用临床和实验室标准研究所的药物敏感性测试标准的研究。随机效应模型用于评估MABC临床分离株对DOX的体外总耐药率，MIN,TGC。采用I2和Cochran的Q统计量来评估异质性的起源。所有分析均使用CMAV.3软件进行。
结果：26篇出版物（关于DOX的22、12和11项研究，MIN,TGC,分别)包括在内。在8μg/mL的断点处，MABC临床分离株对DOX和MIN的合并体外耐药率分别为93.0％（95％CI，89.2％-95.5％）和87.2％（95％CI，76.5％-93.4％），分别。在TGC的情况下，2、4和8μg/mL的断点与2.5％的合并耐药率相关（95％CI，0.5％-11.6％），7.2%（95%CI，4.0%-12.5%），和16.8%（95%CI，4.7%-45.0%），分别。
结论：在三种检查的四环素中，MABC对DOX和MIN表现出极高的耐药率，从而限制了它们在治疗MABC感染中的用途。相反，MABC对TGC的敏感性增加，强调TGC作为MABC感染患者的可行治疗选择。
