Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease.


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
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

1127-1137

Commentaires 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.

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Auteurs

Getahun Abate (G)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

Jack T Stapleton (JT)

Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.

Nadine Rouphael (N)

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Buddy Creech (B)

Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA.

Jason E Stout (JE)

Duke University School of Medicine, Durham, North Carolina, USA.

Hana M El Sahly (HM)

Baylor College of Medicine, Houston, Texas, USA.

Lisa Jackson (L)

Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.

Francisco J Leyva (FJ)

Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.

Kay M Tomashek (KM)

Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.

Melinda Tibbals (M)

Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.

Nora Watson (N)

The Emmes Corporation, Rockville, Maryland, USA.

Aaron Miller (A)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

Edward Charbek (E)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

Joan Siegner (J)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

Marcia Sokol-Anderson (M)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

Ravi Nayak (R)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

Greta Dahlberg (G)

Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.

Pat Winokur (P)

Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.

Ghina Alaaeddine (G)

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Nour Beydoun (N)

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Katherine Sokolow (K)

Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA.

Naomi Prashad Kown (NP)

Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA.

Shanda Phillips (S)

Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA.

Arthur W Baker (AW)

Duke University School of Medicine, Durham, North Carolina, USA.

Nicholas Turner (N)

Duke University School of Medicine, Durham, North Carolina, USA.

Emmanuel Walter (E)

Duke University School of Medicine, Durham, North Carolina, USA.

Elizabeth Guy (E)

Baylor College of Medicine, Houston, Texas, USA.

Sharon Frey (S)

Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA.

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