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Radiographic severity and treatment outcome of Mycobacterium abscessus complex pulmonary disease

  • Jimyung Park
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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  • Soon Ho Yoon
    Affiliations
    Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
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  • Joong-Yub Kim
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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  • Kang-Mo Gu
    Affiliations
    Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
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  • Nakwon Kwak
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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  • Jae-Joon Yim
    Correspondence
    Corresponding author. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
    Affiliations
    Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Published:August 04, 2021DOI:https://doi.org/10.1016/j.rmed.2021.106549

      Highlights

      • There are currently no reliable predictors for treatment response in MABC-PD.
      • Baseline radiographic severity was associated with treatment outcome in MABC-PD.
      • Severity of cavitary lesion was important particularly for M. abscessus-PD.
      • Earlier initiation of antibiotic treatment should be considered for MABC-PD.

      Abstract

      Introduction

      The lack of reliable predictors for the treatment response complicates decisions to initiate treatment in patients with Mycobacterium abscessus complex pulmonary disease (MABC-PD). We aimed to investigate whether baseline radiographic disease severity is associated with treatment outcome in MABC-PD.

      Method

      We retrospectively analyzed 101 patients with MABC-PD (54 with M. abscessus-PD and 47 with M. massiliense-PD) treated in a tertiary referral hospital between January 2006 and December 2019. Using chest computed tomography images, baseline radiographic disease severity was quantitatively scored according to five categories of radiographic lesions (bronchiectasis, bronchiolitis, cavities, nodules, and consolidation).

      Results

      Treatment success was achieved in 53.7% of patients with M. abscessus-PD and 85.1% of patients with M. massiliense-PD. Higher overall scores for baseline radiographic disease severity were associated with treatment failure in patients with M. massiliense-PD (aOR 1.35, 95% CI 1.02–1.79 for each 1-point increase in severity score), as well as in patients with M. abscessus-PD (aOR 1.15, 95% CI 1.00–1.33). This was particularly prominent in patients with overall severity score of ≥14 (aOR 31.16, 95% CI 1.12–868.95 for M. massiliense-PD and aOR 3.55, 95% CI 1.01–12.45 for M. abscessus-PD). Among variable radiographic abnormalities, the score for cavitary lesion severity was associated with treatment failure in patients with M. abscessus-PD (aOR 1.26, 95% CI 1.01–1.56), but not in patients with M. massiliense-PD.

      Conclusions

      Given the association between baseline radiographic disease severity and treatment outcome, initiating treatment should be actively considered before significant progression of radiographic lesions in patients with MABC-PD.

      Keywords

      Abbreviations:

      Adjusted odds ratio (aOR), Computed tomography (CT), Confidence interval (CI), Interquartile range (IQR), Mycobacterium abscessus complex (MABC), Mycobacterium abscessus complex pulmonary disease (MABC-PD), Mycobacterium abscessus pulmonary disease (M. abscessus-PD), Mycobacterium avium complex (MAC), Mycobacterium avium complex pulmonary disease (MAC-PD), Mycobacterium massiliense pulmonary disease (M. massiliense-PD), Nontuberculous mycobacteria (NTM), Nontuberculous mycobacterial pulmonary disease (NTM-PD), Peripherally inserted central catheters (PICC), Receiver operating characteristics (ROC)
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