Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease.
Mycobacterium avium complex
lung
mortality
mycobacteria
treatment outcome
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
08 04 2021
08 04 2021
Historique:
received:
10
10
2019
accepted:
09
03
2020
pubmed:
22
3
2020
medline:
29
4
2021
entrez:
22
3
2020
Statut:
ppublish
Résumé
The increasing global prevalence of pulmonary nontuberculous mycobacteria (NTM) disease has called attention to challenges in NTM diagnosis and management. This study was conducted to understand management and outcomes of patients with pulmonary NTM disease at diverse centers across the United States. We conducted a 10-year (2005-2015) retrospective study at 7 Vaccine and Treatment Evaluation Units to evaluate pulmonary NTM treatment outcomes in human immunodeficiency virus-negative adults. Demographic and clinical information was abstracted through medical record review. Microbiologic and clinical cure were evaluated using previously defined criteria. Of 297 patients diagnosed with pulmonary NTM, the most frequent NTM species were Mycobacterium avium-intracellulare complex (83.2%), M. kansasii (7.7%), and M. abscessus (3.4%). Two hundred forty-five (82.5%) patients received treatment, while 45 (15.2%) were followed without treatment. Eighty-six patients had available drug susceptibility results; of these, >40% exhibited resistance to rifampin, ethambutol, or amikacin. Of the 138 patients with adequate outcome data, 78 (56.5%) experienced clinical and/or microbiologic cure. Adherence to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) treatment guidelines was significantly more common in patients who were cured (odds ratio, 4.5, 95% confidence interval, 2.0-10.4; P < .001). Overall mortality was 15.7%. Despite ATS/IDSA Guidelines, management of pulmonary NTM disease was heterogeneous and cure rates were relatively low. Further work is required to understand which patients are suitable for monitoring without treatment and the impact of antimicrobial therapy on pulmonary NTM morbidity and mortality.
Sections du résumé
BACKGROUND
The increasing global prevalence of pulmonary nontuberculous mycobacteria (NTM) disease has called attention to challenges in NTM diagnosis and management. This study was conducted to understand management and outcomes of patients with pulmonary NTM disease at diverse centers across the United States.
METHODS
We conducted a 10-year (2005-2015) retrospective study at 7 Vaccine and Treatment Evaluation Units to evaluate pulmonary NTM treatment outcomes in human immunodeficiency virus-negative adults. Demographic and clinical information was abstracted through medical record review. Microbiologic and clinical cure were evaluated using previously defined criteria.
RESULTS
Of 297 patients diagnosed with pulmonary NTM, the most frequent NTM species were Mycobacterium avium-intracellulare complex (83.2%), M. kansasii (7.7%), and M. abscessus (3.4%). Two hundred forty-five (82.5%) patients received treatment, while 45 (15.2%) were followed without treatment. Eighty-six patients had available drug susceptibility results; of these, >40% exhibited resistance to rifampin, ethambutol, or amikacin. Of the 138 patients with adequate outcome data, 78 (56.5%) experienced clinical and/or microbiologic cure. Adherence to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) treatment guidelines was significantly more common in patients who were cured (odds ratio, 4.5, 95% confidence interval, 2.0-10.4; P < .001). Overall mortality was 15.7%.
CONCLUSIONS
Despite ATS/IDSA Guidelines, management of pulmonary NTM disease was heterogeneous and cure rates were relatively low. Further work is required to understand which patients are suitable for monitoring without treatment and the impact of antimicrobial therapy on pulmonary NTM morbidity and mortality.
Identifiants
pubmed: 32198521
pii: 5810743
doi: 10.1093/cid/ciaa252
pmc: PMC8028102
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1127-1137Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
BMC Infect Dis. 2018 May 3;18(1):206
pubmed: 29724184
Am J Respir Crit Care Med. 2012 Apr 15;185(8):881-6
pubmed: 22312016
PLoS One. 2013 Nov 12;8(11):e77385
pubmed: 24265675
Am J Respir Crit Care Med. 2017 Mar 15;195(6):814-823
pubmed: 27748623
Emerg Infect Dis. 2009 Oct;15(10):1562-9
pubmed: 19861046
Chest. 2018 Apr;153(4):888-921
pubmed: 29410162
Ann Am Thorac Soc. 2015 Oct;12(10):1458-64
pubmed: 26214350
Eur Respir J. 2017 Feb 15;49(2):
pubmed: 28182571
Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):641-5
pubmed: 10673211
Am J Respir Crit Care Med. 1999 Sep;160(3):866-72
pubmed: 10471610
Eur Respir J. 2011 May;37(5):1158-65
pubmed: 20817704
PLoS Negl Trop Dis. 2017 Aug 7;11(8):e0005841
pubmed: 28787454
Thorax. 1994 May;49(5):442-5
pubmed: 8016763
Chest. 2015 Dec;148(6):1517-1527
pubmed: 26225805
Ann Am Thorac Soc. 2014 Jan;11(1):9-16
pubmed: 24236749
J Clin Microbiol. 2012 Nov;50(11):3556-61
pubmed: 22915613
Am J Respir Crit Care Med. 2011 Feb 1;183(3):405-10
pubmed: 20833823
Clin Microbiol Infect. 2009 Oct;15(10):906-10
pubmed: 19845702
Chest. 2017 Jul;152(1):120-142
pubmed: 28461147
Thorax. 2016 Jan;71(1):88-90
pubmed: 26678435
Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416
pubmed: 17277290
Ann Am Thorac Soc. 2017 Jul;14(7):1112-1119
pubmed: 28387532
Expert Rev Anti Infect Ther. 2013 Oct;11(10):1065-77
pubmed: 24124798
Emerg Infect Dis. 2016 Jun;22(6):1102-5
pubmed: 27191473
Am J Respir Crit Care Med. 2010 Oct 1;182(7):970-6
pubmed: 20538958
Am J Respir Crit Care Med. 2018 Dec 15;198(12):1559-1569
pubmed: 30216086
J Infect Chemother. 2006 Aug;12(4):195-202
pubmed: 16944258
J Thorac Dis. 2014 Mar;6(3):210-20
pubmed: 24624285
Am J Respir Crit Care Med. 2010 Oct 1;182(7):977-82
pubmed: 20508209
Clin Chest Med. 2015 Mar;36(1):67-78
pubmed: 25676520
Eur J Intern Med. 2014 Apr;25(4):356-63
pubmed: 24685313
J Clin Microbiol. 2017 Feb;55(2):380-383
pubmed: 27927928
PLoS One. 2014 Mar 14;9(3):e91879
pubmed: 24632814
Eur J Clin Microbiol Infect Dis. 2012 Aug;31(8):1883-7
pubmed: 22198679
Clin Infect Dis. 2003 Nov 1;37(9):1178-82
pubmed: 14557961
Eur Respir J. 2017 Mar 8;49(3):
pubmed: 28275170
Am J Respir Crit Care Med. 2019 Apr 15;199(8):947-951
pubmed: 30428263
Chest. 2014 Aug;146(2):276-282
pubmed: 24457542
Eur J Clin Microbiol Infect Dis. 2014 Mar;33(3):347-58
pubmed: 23979729
Clin Infect Dis. 2009 Dec 15;49(12):e124-9
pubmed: 19911942
J Infect Chemother. 2012 Aug;18(4):436-43
pubmed: 22205543
Curr Opin Infect Dis. 2012 Apr;25(2):218-27
pubmed: 22327466
Eur Respir J. 2018 Mar 22;51(3):
pubmed: 29567726
Emerg Infect Dis. 2013 Nov;19(11):1889-91
pubmed: 24210012
Clin Infect Dis. 2011 Mar 1;52(5):565-71
pubmed: 21292659