Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease
- 21 March 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 72 (7), 1127-1137
- https://doi.org/10.1093/cid/ciaa252
Abstract
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.Funding Information
- National Institute of Allergy and Infectious Diseases
- National Institutes of Health
- Saint Louis University (HHSN272201300021I)
- Emory University School of Medicine (HHSN272201300018I)
- University of Iowa (HHSN272201300020I)
- Baylor College of Medicine (HHSN272201300015I)
- Duke University School of Medicine (HHSN272201300017I)
- Vanderbilt University Medical Center (HHSN272201300023I)
- Kaiser Permanente Washington Health Research Institute (HHSN272201300019I)
- Emmes Corporation (HSN272201500002C)
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