Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium.
Bryant JM., Grogono DM., Rodriguez-Rincon D., Everall I., Brown KP., Moreno P., Verma D., Hill E., Drijkoningen J., Gilligan P., Esther CR., Noone PG., Giddings O., Bell SC., Thomson R., Wainwright CE., Coulter C., Pandey S., Wood ME., Stockwell RE., Ramsay KA., Sherrard LJ., Kidd TJ., Jabbour N., Johnson GR., Knibbs LD., Morawska L., Sly PD., Jones A., Bilton D., Laurenson I., Ruddy M., Bourke S., Bowler IC., Chapman SJ., Clayton A., Cullen M., Daniels T., Dempsey O., Denton M., Desai M., Drew RJ., Edenborough F., Evans J., Folb J., Humphrey H., Isalska B., Jensen-Fangel S., Jönsson B., Jones AM., Katzenstein TL., Lillebaek T., MacGregor G., Mayell S., Millar M., Modha D., Nash EF., O'Brien C., O'Brien D., Ohri C., Pao CS., Peckham D., Perrin F., Perry A., Pressler T., Prtak L., Qvist T., Robb A., Rodgers H., Schaffer K., Shafi N., van Ingen J., Walshaw M., Watson D., West N., Whitehouse J., Haworth CS., Harris SR., Ordway D., Parkhill J., Floto RA.
Lung infections with Mycobacterium abscessus, a species of multidrug-resistant nontuberculous mycobacteria, are emerging as an important global threat to individuals with cystic fibrosis (CF), in whom M. abscessus accelerates inflammatory lung damage, leading to increased morbidity and mortality. Previously, M. abscessus was thought to be independently acquired by susceptible individuals from the environment. However, using whole-genome analysis of a global collection of clinical isolates, we show that the majority of M. abscessus infections are acquired through transmission, potentially via fomites and aerosols, of recently emerged dominant circulating clones that have spread globally. We demonstrate that these clones are associated with worse clinical outcomes, show increased virulence in cell-based and mouse infection models, and thus represent an urgent international infection challenge.