Abstract
Mycobacterium marinum, a well-recognized cutaneous pathogen, is usually treated by chemotherapy without available standardized in vitro susceptibility testing information. In this study, we have attempted to apply the stable-gradient method (Etest; AB Biodisk, Solna, Sweden) to susceptibility testing of M. marinum in order to assess the activities of eight antimicrobial agents against 60 recent clinical strains of M. marinum collected from 10 geographic sites within the United States. Two plated media (5% sheep blood Mueller-Hinton agar and Middlebrook 7H11 agar) were compared, and 7H11 agar was found to be superior in supporting the growth of all strains. Four reference strains of M. marinum were tested on five occasions with eight drugs (160 tests) in order to evaluate Etest reproducibility. Results were observed to be within 1 log2 dilution of the all-test median MIC for 97.5% of the Etests. Our MIC results for the 60 strains clearly demonstrate the best in vitro potency against M. marinum isolates to be as follows (rank order): trimethoprim-sulfamethoxazole (MIC at which 90% of the isolates are inhibited [MIC90], 0.25 and 4.25 microg/ml, respectively) = ethambutol > clarithromycin (MIC90, 1 microg/ml) > minocycline = doycycline (MIC90, 4 microg/ml) > amikacin (MIC90, 8 microg/ml). Rifampin was only marginally active against the M. marinum strains tested (MIC90, at the National Committee for Clinical Laboratory Standards) breakpoint of 1 microg/ml), and ciprofloxacin was not active (MIC90, 8 microg/ml). These data should enhance the empiric drug selection for contemporary M. marinum infections and also provide evidence that the Etest can be utilized to guide chemotherapy with alternative agents.
Full Text
The Full Text of this article is available as a PDF (198.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Chow S. P., Ip F. K., Lau J. H., Collins R. J., Luk K. D., So Y. C., Pun W. K. Mycobacterium marinum infection of the hand and wrist. Results of conservative treatment in twenty-four cases. J Bone Joint Surg Am. 1987 Oct;69(8):1161–1168. [PubMed] [Google Scholar]
- Collins C. H., Uttley A. H. In-vitro activity of seventeen antimicrobial compounds against seven species of mycobacteria. J Antimicrob Chemother. 1988 Dec;22(6):857–861. doi: 10.1093/jac/22.6.857. [DOI] [PubMed] [Google Scholar]
- Edelstein H. Mycobacterium marinum skin infections. Report of 31 cases and review of the literature. Arch Intern Med. 1994 Jun 27;154(12):1359–1364. doi: 10.1001/archinte.154.12.1359. [DOI] [PubMed] [Google Scholar]
- Forsgren A. Antibiotic susceptibility of Mycobacterium marinum. Scand J Infect Dis. 1993;25(6):779–782. doi: 10.3109/00365549309008579. [DOI] [PubMed] [Google Scholar]
- Hanau L. H., Leaf A., Soeiro R., Weiss L. M., Pollack S. S. Mycobacterium marinum infection in a patient with the acquired immunodeficiency syndrome. Cutis. 1994 Aug;54(2):103–105. [PubMed] [Google Scholar]
- Harris L. F., Striplin W. H., Burnside R. C. Aquatic hazard Mycobacterium marinum infection. Ala Med. 1991 Oct;61(4):8–10. [PubMed] [Google Scholar]
- Hoyt R. E., Bryant J. E., Glessner S. F., Littleton F. C., Jr, Sawyer R. W., Newman R. J., Nichols D. B., Franco A. P., Jr, Tingle N. R., Jr M marinum infections in a Chesapeake Bay community. Va Med. 1989 Nov;116(11):467–470. [PubMed] [Google Scholar]
- Hurst L. C., Amadio P. C., Badalamente M. A., Ellstein J. L., Dattwyler R. J. Mycobacterium marinum infections of the hand. J Hand Surg Am. 1987 May;12(3):428–435. doi: 10.1016/s0363-5023(87)80018-7. [DOI] [PubMed] [Google Scholar]
- Johnston J. M., Izumi A. K. Cutaneous Mycobacterium marinum infection ("swimming pool granuloma"). Clin Dermatol. 1987 Jul-Sep;5(3):68–75. doi: 10.1016/s0738-081x(87)80011-1. [DOI] [PubMed] [Google Scholar]
- Jolly H. W., Jr, Seabury J. H. Infections with Myocbacterium marinum. Arch Dermatol. 1972 Jul;106(1):32–36. [PubMed] [Google Scholar]
- Koontz F. P., Erwin M. E., Barrett M. S., Jones R. N. Etest for routine clinical antimicrobial susceptibility testing of rapid-growing mycobacteria isolates. Diagn Microbiol Infect Dis. 1994 Jul;19(3):183–186. doi: 10.1016/0732-8893(94)90065-5. [DOI] [PubMed] [Google Scholar]
- LINELL F., NORDEN A. Mycobacterium balnei, a new acid-fast bacillus occurring in swimming pools and capable of producing skin lesions in humans. Acta Tuberc Scand Suppl. 1954;33:1–84. [PubMed] [Google Scholar]
- PHILPOTT J. A., Jr, WOODBURNE A. R., PHILPOTT O. S., SCHAEFER W. B., MOLLOHAN C. S. SWIMMING POOL GRANULOMA. A STUDY OF 290 CASES. Arch Dermatol. 1963 Aug;88:158–162. doi: 10.1001/archderm.1963.01590200046008. [DOI] [PubMed] [Google Scholar]
- Sanders W. J., Wolinsky E. In vitro susceptibility of Mycobacterium marinum to eight antimicrobial agents. Antimicrob Agents Chemother. 1980 Oct;18(4):529–531. doi: 10.1128/aac.18.4.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stone M. S., Wallace R. J., Jr, Swenson J. M., Thornsberry C., Christensen L. A. Agar disk elution method for susceptibility testing of Mycobacterium marinum and Mycobacterium fortuitum complex to sulfonamides and antibiotics. Antimicrob Agents Chemother. 1983 Oct;24(4):486–493. doi: 10.1128/aac.24.4.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vazquez J. A., Sobel J. D. A case of disseminated Mycobacterium marinum infection in an immunocompetent patient. Eur J Clin Microbiol Infect Dis. 1992 Oct;11(10):908–911. doi: 10.1007/BF01962371. [DOI] [PubMed] [Google Scholar]
- Wallace R. J., Jr, Nash D. R., Steele L. C., Steingrube V. Susceptibility testing of slowly growing mycobacteria by a microdilution MIC method with 7H9 broth. J Clin Microbiol. 1986 Dec;24(6):976–981. doi: 10.1128/jcm.24.6.976-981.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wanger A., Mills K. Etest for susceptibility testing of Mycobacterium tuberculosis and Mycobacterium avium-intracellulare. Diagn Microbiol Infect Dis. 1994 Jul;19(3):179–181. doi: 10.1016/0732-8893(94)90064-7. [DOI] [PubMed] [Google Scholar]
- Zeligman I. Mycobacterium marinum granuloma. A disease acquired in the tributaries of Chesapeake Bay. Arch Dermatol. 1972 Jul;106(1):26–31. doi: 10.1001/archderm.106.1.26. [DOI] [PubMed] [Google Scholar]
