Antimycobacterial Consideration in Transplantation Including Drug Non-susceptibility and Resistance: Tuberculosis and Nontuberculous Mycobacterial Disease

  • Julie V. Philley
  • David E. GriffithEmail author


Mycobacterial disease is commonly encountered during transplant evaluations and can be a major source of morbidity and mortality among transplant recipients. The impact of TB and NTM around the world has gained increased awareness, and the global impact of disease varies from country to country thus making mycobacterial epidemiology an important aspect of disease management. Risk factors for both tuberculosis (TB) and nontuberculous mycobacteria (NTM) must be assessed by transplant providers, and a low index of suspicion should warrant a prompt and accurate work-up to identify disease. Evaluation for active and latent TB is necessary prior to transplant. Preventing drug resistance for both TB and NTM plays a critical role in treatment options and outcomes. Adequate laboratory services are an essential component of drug regimens and often require reference laboratory assistance. Treatment regimens for mycobacterial disease require multiple antibiotics and frequently are associated with a host of drug-drug interactions. Knowledge of mycobacterial disease diagnosis, treatment regimens, and susceptibility patterns are essential to transplant evaluation and success.


Tuberculosis TB MTB Nontuberculous NTM Mycobacteria Mycobacterium Transplant Solid organ Latent 


  1. 1.
    Ramaswamy S, Musser JM. Molecular genetic basis of antimicrobial agent resistance in Mycobacterium tuberculosis: 1998 update. Tuber Lung Dis. 1998;79(1):3–29.PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization (WHO) global TB report, 2016.Google Scholar
  3. 3.
    Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175(4):367–416. Review. Erratum in: Am J Respir Crit Care Med. 2007 Apr 1;175(7):744–5. Dosage error in article text.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Brown-Elliott BA, Iakhiaeva E, Griffith DE, Woods GL, Stout JE, Wolfe CR, et al. 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. J Clin Microbiol. 2013;51(10):3389–94. Erratum in: J Clin Microbiol. 2014;52(4):1311.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Griffith DE, Brown-Elliott BA, Langsjoen B, Zhang Y, Pan X, Girard W, et al. Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2006;174(8):928–34.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    van Ingen J, Boeree MJ, van Soolingen D, Mouton JW. Resistance mechanisms and drug susceptibility testing of nontuberculous mycobacteria. Drug Resist Updat. 2012;15(3):149–61.PubMedCrossRefGoogle Scholar
  7. 7.
    Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother. 2009;53(4):1367–76.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Brown-Elliott BA, Vasireddy S, Vasireddy R, Iakhiaeva E, Howard ST, Nash K, et al. Utility of sequencing the erm(41) gene in isolates of Mycobacterium abscessus subsp. abscessus with low and intermediate clarithromycin MICs. J Clin Microbiol. 2015;53(4):1211–5. Erratum in: J Clin Microbiol. 2016;54(4):1172.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: impact and implications for management. Clin Infect Dis. 1998;27(5):1266–77.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Queipo JA, Broseta E, Santos M, Sánchez-Plumed J, Budía A, Jiménez-Cruz F. Mycobacterial infection in a series of 1261 renal transplant recipients. Clin Microbiol Infect. 2003;9(6):518–25.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Muñoz P, Rodríguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis. 2005;40(4):581–7. Review.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Meije Y, Piersimoni C, Torre-Cisneros J, Dilektasli AG, Aguado JM, ESCMID Study Group of Infection in Compromised Hosts. Mycobacterial infections in solid organ transplant recipients. Clin Microbiol Infect. 2014;20(Suppl 7):89–101.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Morris MI, Daly JS, Blumberg E, Kumar D, Sester M, Schluger N, et al. Diagnosis and management of tuberculosis in transplant donors: a donor-derived infections consensus conference report. Am J Transplant. 2012;12(9):2288–300.CrossRefGoogle Scholar
  14. 14.
    Bumbacea D, Arend SM, Eyuboglu F, Fishman JA, Goletti D, Ison MG, et al. The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement. Eur Respir J. 2012;40(4):990–1013.CrossRefGoogle Scholar
  15. 15.
    Klote MM, Agodoa LY, Abbott K. Mycobacterium tuberculosis infection incidence in hospitalized renal transplant patients in the United States, 1998-2000. Am J Transplant. 2004;4(9):1523–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Abbott KC, Klote MM. Update on guidelines for prevention and management of mycobacterium tuberculosis infections after transplant. Am J Transplant. 2005;5(5):1163.PubMedCrossRefGoogle Scholar
  17. 17.
    Morales P, Briones A, Torres JJ, Solé A, Pérez D, Pastor A. Pulmonary tuberculosis in lung and heart-lung transplantation: fifteen years of experience in a single center in Spain. Transplant Proc. 2005;37(9):4050–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Clemente WT, Faria LC, Lima SS, Vilela EG, Lima AS, Velloso LF, et al. Tuberculosis in liver transplant recipients: a single Brazilian center experience. Transplantation. 2009;87(3):397–401.PubMedCrossRefGoogle Scholar
  19. 19.
    Scott C, Kirking HL, Jeffries C, Price SF, Pratt R, Centers for Disease Control and Prevention (CDC). Tuberculosis trends--United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(10):265–9.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for disease control and prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64(2):111–5.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Redelman-Sidi G, Sepkowitz KA. IFN-γ release assays in the diagnosis of latent tuberculosis infection among immunocompromised adults. Am J Respir Crit Care Med. 2013;188(4):422–31. ReviewPubMedCrossRefGoogle Scholar
  22. 22.
    Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med. 2008;149(3):177–84. ReviewPubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Sester U, Wilkens H, van Bentum K, Singh M, Sybrecht GW, et al. Impaired detection of Mycobacterium tuberculosis immunity in patients using high levels of immunosuppressive drugs. Eur Respir J. 2009;34(3):702–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Diel R, Loddenkemper R, Meywald-Walter K, Niemann S, Nienhaus A. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med. 2008;177(10):1164–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Mancuso JD, Mazurek GH, Tribble D, Olsen C, Aronson NE, Geiter L, et al. Discordance among commercially available diagnostics for latent tuberculosis infection. Am J Respir Crit Care Med. 2012;185(4):427–34.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Cattamanchi A, Smith R, Steingart KR, Metcalfe JZ, Date A, Coleman C, et al. Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2011;56(3):230–8.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Talati NJ, Seybold U, Humphrey B, Aina A, Tapia J, Weinfurter P, et al. Poor concordance between interferon-gamma release assays and tuberculin skin tests in diagnosis of latent tuberculosis infection among HIV-infected individuals. BMC Infect Dis. 2009;9:15.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep. 2000;49(RR-6):1–51.Google Scholar
  29. 29.
    Adamu B, Abdu A, Abba AA, Borodo MM, Tleyjeh IM. Antibiotic prophylaxis for preventing post solid organ transplant tuberculosis. Cochrane Database Syst Rev. 2014;3:CD008597.Google Scholar
  30. 30.
    Holty JE, Gould MK, Meinke L, Keeffe EB, Ruoss SJ. Tuberculosis in liver transplant recipients: a systematic review and meta-analysis of individual patient data. Liver Transpl. 2009;15(8):894–906.PubMedCrossRefGoogle Scholar
  31. 31.
    Aguado JM, Torre-Cisneros J, Fortún J, Benito N, Meije Y, et al. Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology. Clin Infect Dis. 2009;48(9):1276–84.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Stucchi RS, Boin IF, Angerami RN, Zanaga L, Ataide EC, Udo EY. Is isoniazid safe for liver transplant candidates with latent tuberculosis? Transplant Proc. 2012;44(8):2406–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Singh N, Wagener MM, Gayowski T. Safety and efficacy of isoniazid chemoprophylaxis administered during liver transplant candidacy for the prevention of posttransplant tuberculosis. Transplantation. 2002;74(6):892–5.CrossRefGoogle Scholar
  34. 34.
    Agoglia L, Balbi E, Halpern M, Roma J, Carius L, Martinho JM, Moreira LP. Tuberculosis in liver transplant recipients: prophylaxis in an endemic area. Transplant Proc. 2011;43(1):199–202.PubMedCrossRefGoogle Scholar
  35. 35.
    Moon HH, Park SY, Kim JM, Park JB, Kwon CHD, Peck KR, et al. Isoniazid prophylaxis for latent tuberculosis infections in liver transplant. Recipients in a tuberculosis-endemic area. Ann Transplant. 2017 [revised 2017 Jan 1];22:338–345.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Trofe-Clark J, Lemonovich TL. AST infectious diseases Community of Practice. Interactions between anti-infective agents and immunosuppressants in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):318–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Sidhu A, Verma G, Humar A, Kumar D. Outcome of latent tuberculosis infection in solid organ transplant recipients over a 10-year period. Transplantation. 2014;98(6):671–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Sterling TR, Scott NA, Miro JM, Calvet G, La Rosa A, Infante R, Tuberculosis Trials Consortium, the AIDS Clinical Trials Group for the PREVENT TB Trial (TBTC Study 26ACTG 5259) The investigators of the TB Trials Consortium and the AIDS Clinical Trials Group for the PREVENT TB Trial are listed in the Supplement, item 17, et al. Three months of weekly rifapentine and isoniazid for treatment of Mycobacterium tuberculosis infection in HIV-coinfected persons. AIDS. 2016;30(10):1607–15.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Sterling TR, Villarino ME, Borisov AS, Shang N, Gordin F, Bliven-Sizemore E, TB Trials Consortium PREVENT TB Study Team, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365(23):2155–66.PubMedCrossRefGoogle Scholar
  40. 40.
    Martinson NA, Barnes GL, Moulton LH, Msandiwa R, Hausler H, Ram M, et al. New regimens to prevent tuberculosis in adults with HIV infection. N Engl J Med. 2011;365(1):11–20.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Bamrah S, Brostrom R, Dorina F, Setik L, Song R, Kawamura LM, et al. Treatment for LTBI in contacts of MDR-TB patients, Federated States of Micronesia, 2009-2012. Int J Tuberc Lung Dis. 2014;18(8):912–8.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Sester M, Sotgiu G, Lange C, Giehl C, Girardi E, Migliori GB, et al. Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2011;37(1):100–11. Erratum in: Eur Respir J. 2012;39(3):793.PubMedCrossRefGoogle Scholar
  43. 43.
    Steingart KR, Schiller I, Horne DJ, Pai M, Boehme CC, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2014;1:CD009593.Google Scholar
  44. 44.
    Tans-Kersten J, Grace Lin SY, Desmond E, Warshauer D. Evaluating shared laboratory services: detecting mycobacterium tuberculosis complex and drug resistance using molecular and culture-based methods. Public Health Rep. 2016;131(1):117–25.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Yakrus MA, Driscoll J, Lentz AJ, Sikes D, Hartline D, Metchock B, Starks AM. Concordance between molecular and phenotypic testing of Mycobacterium tuberculosis complex isolates for resistance to rifampin and isoniazid in the United States. J Clin Microbiol. 2014;52(6):1932–7.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Bhaloo S, Prasad GV. Severe reduction in tacrolimus levels with rifampin despite multiple cytochrome P450 inhibitors: a case report. Transplant Proc. 2003;35(7):2449–51.PubMedCrossRefGoogle Scholar
  47. 47.
    Offermann G, Keller F, Molzahn M. Low cyclosporin A blood levels and acute graft rejection in a renal transplant recipient during rifampin treatment. Am J Nephrol. 1985;5(5):385–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Sun HY, Munoz P, Torre-Cisneros J, Aguado JM, Lattes R, Montejo M, et al. Tuberculosis in solid-organ transplant recipients: disease characteristics and outcomes in the current era. Prog Transplant. 2014;24(1):37–43.PubMedCrossRefGoogle Scholar
  49. 49.
    Ha YE, Joo EJ, Park SY, Wi YM, Kang CI, Chung DR, et al. Tacrolimus as a risk factor for tuberculosis and outcome of treatment with rifampicin in solid organ transplant recipients. Transpl Infect Dis. 2012;14(6):626–34.PubMedCrossRefGoogle Scholar
  50. 50.
    Hsu MS, Wang JL, Ko WJ, Lee PH, Chou NK, Wang SS, et al. Clinical features and outcome of tuberculosis in solid organ transplant recipients. Am J Med Sci. 2007;334(2):106–10.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Chou NK, Wang JL, Chi NH, Wu IH, Huang SC, Chen YS, et al. Tuberculosis after heart transplantation: twenty years of experience in a single center in Taiwan. Transplant Proc. 2008;40(8):2631–3.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Sun HY. Treating tuberculosis in solid organ transplant recipients. Curr Opin Infect Dis. 2014;27(6):501–5.CrossRefGoogle Scholar
  53. 53.
    EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient. Nephrol Dial Transplant. 2002;17(Suppl 4):1–67.Google Scholar
  54. 54.
    Drug-resistant tuberculosis: a survival guide for clinicians. 3rd ed. Curry Center; 2016.Google Scholar
  55. 55.
    Shin S, Furin J, Alcántara F, Hyson A, Joseph K, Sánchez E, Rich M. Hypokalemia among patients receiving treatment for multidrug-resistant tuberculosis. Chest. 2004;125(3):974–80.PubMedCrossRefGoogle Scholar
  56. 56.
    Gillespie SH, Kennedy N. Fluoroquinolones: a new treatment for tuberculosis? Int J Tuberc Lung Dis. 1998;2(4):265–71. ReviewPubMedGoogle Scholar
  57. 57.
    Ginsburg AS, Grosset JH, Bishai WR. Fluoroquinolones, tuberculosis, and resistance. Lancet Infect Dis. 2003;3(7):432–42. ReviewPubMedCrossRefGoogle Scholar
  58. 58.
    Peloquin CA, Hadad DJ, Molino LP, Palaci M, Boom WH, Dietze R, Johnson JL. Population pharmacokinetics of levofloxacin, gatifloxacin, and moxifloxacin in adults with pulmonary tuberculosis. Antimicrob Agents Chemother. 2008;52(3):852–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Yew WW, Chan CK, Leung CC, Chau CH, Tam CM, Wong PC, Lee J. Comparative roles of levofloxacin and ofloxacin in the treatment of multidrug-resistant tuberculosis: preliminary results of a retrospective study from Hong Kong. Chest. 2003;124(4):1476–81.PubMedCrossRefGoogle Scholar
  60. 60.
    Devasia RA, Blackman A, Gebretsadik T, Griffin M, Shintani A, May C, et al. Fluoroquinolone resistance in Mycobacterium tuberculosis: the effect of duration and timing of fluoroquinolone exposure. Am J Respir Crit Care Med. 2009;180(4):365–70.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Long R, Chong H, Hoeppner V, Shanmuganathan H, Kowalewska-Grochowska K, Shandro C, et al. Empirical treatment of community-acquired pneumonia and the development of fluoroquinolone-resistant tuberculosis. Clin Infect Dis. 2009;48(10):1354–60.PubMedCrossRefGoogle Scholar
  62. 62.
    Lee CN, Lin TP, Chang MF, Jimenez MV, Dolfi L, Olliaro P. Rifabutin as salvage therapy for cases of chronic multidrug-resistant pulmonary tuberculosis in Taiwan. J Chemother. 1996;8(2):137–43.PubMedCrossRefGoogle Scholar
  63. 63.
    Dietze R, Hadad DJ, McGee B, Molino LP, Maciel EL, Peloquin CA, et al. Early and extended early bactericidal activity of linezolid in pulmonary tuberculosis. Am J Respir Crit Care Med. 2008;178(11):1180–5.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Condos R, Hadgiangelis N, Leibert E, Jacquette G, Harkin T, Rom WN. Case series report of a linezolid-containing regimen for extensively drug-resistant tuberculosis. Chest. 2008;134(1):187–92.PubMedCrossRefGoogle Scholar
  65. 65.
    Migliori GB, Eker B, Richardson MD, Sotgiu G, Zellweger JP, Skrahina A, TBNET Study Group, et al. A retrospective TBNET assessment of linezolid safety, tolerability and efficacy in multidrug-resistant tuberculosis. Eur Respir J. 2009;34(2):387–93.PubMedCrossRefGoogle Scholar
  66. 66.
    Koh WJ, Shim TS. Daily 300 mg dose of linezolid for the treatment of intractable multidrug-resistant and extensively drug-resistant tuberculosis—authors’ response. J Antimicrob Chemother. 2009;64(5):1119–20. Scholar
  67. 67.
    Yew WW, Chang KC, Chau CH. What is the optimal dosage of linezolid in treatment of complicated multidrug-resistant tuberculosis? Eur Respir J. 2009;34(6):1492–4.PubMedCrossRefGoogle Scholar
  68. 68.
    Schecter GF, Scott C, True L, Raftery A, Flood J, Mase S. Linezolid in the treatment of multidrug-resistant tuberculosis. Clin Infect Dis. 2010;50(1):49–55.PubMedCrossRefGoogle Scholar
  69. 69.
    Beekmann SE, Gilbert DN, Polgreen PM, IDSA Emerging Infections Network. Toxicity of extended courses of linezolid: results of an Infectious Diseases Society of America Emerging Infections Network survey. Diagn Microbiol Infect Dis. 2008;62(4):407–10.PubMedCrossRefGoogle Scholar
  70. 70.
    Garrabou G, Soriano A, López S, Guallar JP, Giralt M, Villarroya F, et al. Reversible inhibition of mitochondrial protein synthesis during linezolid-related hyperlactatemia. Antimicrob Agents Chemother. 2007;51(3):962–7.PubMedCrossRefGoogle Scholar
  71. 71.
    McKee EE, Ferguson M, Bentley AT, Marks TA. Inhibition of mammalian mitochondrial protein synthesis by oxazolidinones. Antimicrob Agents Chemother. 2006;50(6):2042–9.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Narita M, Tsuji BT, Yu VL. Linezolid-associated peripheral and optic neuropathy, lactic acidosis, and serotonin syndrome. Pharmacotherapy. 2007;27(8):1189–97. ReviewPubMedCrossRefGoogle Scholar
  73. 73.
    Bishop E, Melvani S, Howden BP, Charles PG, Grayson ML. Good clinical outcomes but high rates of adverse reactions during linezolid therapy for serious infections: a proposed protocol for monitoring therapy in complex patients. Antimicrob Agents Chemother. 2006;50(4):1599–602.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Papastavros T, Dolovich LR, Holbrook A, Whitehead L, Loeb M. Adverse events associated with pyrazinamide and levofloxacin in the treatment of latent multidrug-resistant tuberculosis. CMAJ. 2002;167(2):131–6.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Younossian AB, Rochat T, Ketterer JP, Wacker J, Janssens JP. High hepatotoxicity of pyrazinamide and ethambutol for treatment of latent tuberculosis. Eur Respir J. 2005;26(3):462–4.PubMedCrossRefGoogle Scholar
  76. 76.
    Koh WJ, Stout JE, Yew WW. Advances in the management of pulmonary disease due to Mycobacterium abscessus complex. Int J Tuberc Lung Dis. 2014;18(10):1141–8.PubMedCrossRefGoogle Scholar
  77. 77.
    Koh WJ, Jeon K, Lee NY, Kim BJ, Kook YH, Lee SH, et al. Clinical significance of differentiation of Mycobacterium massiliense from Mycobacterium abscessus. Am J Respir Crit Care Med. 2011;183(3):405–10.PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Choi GE, Shin SJ, Won CJ, Min KN, Oh T, Hahn MY, et al. Macrolide treatment for Mycobacterium abscessus and Mycobacterium massiliense infection and inducible resistance. Am J Respir Crit Care Med. 2012;186(9):917–25.PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.University of Texas Health Science Center at Tyler, Department of Pulmonary and Critical Care MedicineTylerUSA
  2. 2.University of Texas Health Science CenterTylerUSA
  3. 3.Heartland National TB CenterTylerUSA

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