Diagnostic challenges in Mycobacterium abscessus pulmonary disease, particularly in patients with cystic fibrosis: toward an integrated precision framework

ABSTRACT Mycobacterium abscessus has emerged as one of the most formidable pathogens affecting people with cystic fibrosis (pwCF), driven by intrinsic antimicrobial resistance, complex taxonomy, and substantial diagnostic uncertainty. Despite major technological advances, establishing a diagnosis of pulmonary disease remains challenging, as traditional culture-based workflows are constrained by limited sensitivity, prolonged turnaround times. However, recent progress in proteomic and genomic technologies has markedly improved organism detection and taxonomic resolution. This review examines the contemporary diagnostic architecture for M. abscessus pulmonary infection in pwCF, identifying persistent gaps, and proposes a precision-oriented framework in which culture, proteomics, genomics, and host-response biomarkers converge to support earlier and more individualized clinical decision-making.