P-763. Assessment of the in vitro potency of anti-mycobacterial agents against clinical Mycobacterium avium complex (MAC) pulmonary isolates: implications of intravenous and inhaled amikacin breakpoint reporting
Abstract
Abstract Background MAC pulmonary disease is associated with significant morbidity and requires multi-drug treatment for extended periods. The novel dosage form amikacin liposome inhalation suspension (ALIS) represents a much-needed treatment option and is noted to have success at MICs of ≤64mg/L, higher than the intravenous (IV) amikacin (AMK) breakpoint (≤16 mg/L) due to optimized pulmonary exposure. Herein, we assessed the in vitro potency of AMK utilizing both ALIS and IV breakpoints as well as other standard antimycobacterial agents. Methods MAC isolates obtained from sputum, bronchoalveolar lavage, or lung tissue culture between 1/1/2018 - 3/1/24 were assessed. The first isolate per patient per year was assessed. MICs were collected from the medical record as determined by standard methods at one of two reference laboratories. If a single sample had two MIC values reported, the more conservative was used for analysis. MICs to AMK, clarithromycin (CLR), moxifloxacin (MXF), and linezolid (LNZ) were collected. Data were assessed as MIC50/90 (mg/L) and categorized per CLSI breakpoints. Patients were classified as receiving MAC directed treatment based on documentation in the medical record. If treatment data was unknown, patients were classified as indeterminate treatment. Results 218 samples were included from 178 patients. CLR was the most active agent with 97% of isolates testing as susceptible (MIC50/90, 0.5/2). MXF and LNZ had relatively poor activity with 82% and 66%…
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