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)To read this article in full you will need to make a payment
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References
- Geographic distribution of nontuberculous mycobacterial species identified among clinical isolates in the United States, 2009-2013.Ann Am Thorac Soc. 2017; 14: 1655-1661https://doi.org/10.1513/AnnalsATS.201611-860OC
- A laboratory-based analysis of nontuberculous mycobacterial lung disease in Japan from 2012 to 2013,.Ann Am Thorac Soc. 2017; 14: 49-56https://doi.org/10.1513/AnnalsATS.201607-573OC
- NTM working group at queensland TB control centre and queensland mycobacterial reference laboratory, changing epidemiology of pulmonary nontuberculous mycobacteria infections.Emerg. Infect. Dis. 2010; 16: 1576-1583https://doi.org/10.3201/eid1610.091201
- Mycobacterium abscessus pulmonary disease: individual patient data meta-analysis.Eur. Respir. J. 2019; 54 (1801991)https://doi.org/10.1183/13993003.01991-2018
- Of lung disease caused by Mycobacterium abscessus and Mycobacterium massiliense.Clin. Infect. Dis. 2017; 64: 301-308https://doi.org/10.1093/cid/ciw723
- Assessment of clarithromycin susceptibility in strains belonging to the Mycobacterium abscessus group by erm(41) and rrl sequencing.Antimicrob. Agents Chemother. 2011; 55: 775-781https://doi.org/10.1128/aac.00861-10
- Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline.Eur. Respir. J. 2020; 56 (2000535)https://doi.org/10.1183/13993003.00535-2020
- Criteria for identification of bacteria and fungi by targeted DNA sequencing. 2nd ed. CLSI guideline MM18 clinical and laboratory standards Institute.(Wayne, PA)2018
- Utility of rpoB gene sequencing for identification of nontuberculous mycobacteria in The Netherlands.J. Clin. Microbiol. 2014; 52: 2544-2551https://doi.org/10.1128/JCM.00233-14
- Standards for Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomycetes. 1st Ed. CLSI Supplement M62.Clinical and Laboratory Standards Institute, Wayne, PA2018
- Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy.Radiology. 2012; 263: 260-270https://doi.org/10.1148/radiol.12111374
- High-resolution CT findings of Mycobacterium avium-intracellulare complex pulmonary disease: correlation with pulmonary function test results.AJR Am. J. Roentgenol. 2008; 191 (W160)https://doi.org/10.2214/AJR.07.3505
- For NTM-NET, Treatment outcome definitions in nontuberculous mycobacterial pulmonary disease: an NTM-NET consensus statement.Eur. Respir. J. 2018; 51 (1800170)https://doi.org/10.1183/13993003.00170-2018
- Microbiological and clinical outcomes of treating non-Mycobacterium avium complex nontuberculous mycobacterial pulmonary disease: a systematic review and meta-analysis,.Chest. 2017; 152: 120-142https://doi.org/10.1016/j.chest.2017.04.166
- Control of confounding and reporting of results in causal inference studies. Guidance for authors from.Ann Am Thorac Soc. 2019; 16: 22-28https://doi.org/10.1513/AnnalsATS.201808-564PS
- Clinical significance of differentiation of Mycobacterium massiliense from Mycobacterium abscessus.Am. J. Respir. Crit. Care Med. 2011; 183: 405-410https://doi.org/10.1164/rccm.201003-0395OC
- Incidence and prevalence of nontuberculous mycobacterial lung disease in a large U.S. Managed care health plan, 2008-2015.Ann Am Thorac Soc. 2020; 17: 178-185https://doi.org/10.1513/AnnalsATS.201804-236OC
- Epidemiology of nontuberculous mycobacterial infection, South Korea, 2007-2016.Emerg. Infect. Dis. 2019; 25: 569-572https://doi.org/10.3201/eid2503.181597
- Rapid increase of non-tuberculous mycobacterial lung diseases at a tertiary referral hospital in South Korea.Int. J. Tubercul. Lung Dis. 2010; 14: 1069-1071
- Treatment outcomes of Mycobacterium avium complex lung disease: a systematic review and meta-analysis,.Clin. Infect. Dis. 2017; 65: 1077-1084https://doi.org/10.1093/cid/cix517
- Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea: a nationwide population-based study, BMC Pulm Med.19. 2019; 140https://doi.org/10.1186/s12890-019-0901-z
- Prognostic factors associated with long-term mortality in 1445 patients with nontuberculous mycobacterial pulmonary disease: a 15-year follow-up study.Eur. Respir. J. 2020; 55 (1900798)https://doi.org/10.1183/13993003.00798-2019
- Longitudinal changes in health-related quality of life according to clinical course among patients with non-tuberculous mycobacterial pulmonary disease: a prospective cohort study, BMC Pulm Med 2050. 126. 2020https://doi.org/10.1186/s12890-020-1165-3
- Ann Am Thorac Soc. 2016; 13: 40-48https://doi.org/10.1513/AnnalsATS.201508-529OC
- Outcomes of Mycobacterium avium complex lung disease based on clinical phenotype.Eur. Respir. J. 2017; 50 (1602503)https://doi.org/10.1183/13993003.02503-2016
- Prognostic factors of 634 HIV-negative patients with Mycobacterium avium complex lung disease.Am. J. Respir. Crit. Care Med. 2012; 185: 575-583https://doi.org/10.1164/rccm.201107-1203OC
- Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease.Am. J. Respir. Crit. Care Med. 2006; 173: 1283-1289https://doi.org/10.1164/rccm.200509-1531OC
- Clofazimine-containing regimen for the treatment of mycobacterium abscessus lung disease.Antimicrob. Agents Chemother. 2017 Jun; 61e02052-16
- Randomized trial of liposomal amikacin for inhalation in nontuberculous mycobacterial lung disease.Am. J. Respir. Crit. Care Med. 2017; 195: 814-823https://doi.org/10.1164/rccm.201604-0700OC
- Clinical experience in 52 patients with tigecycline-containing regimens for salvage treatment of Mycobacterium abscessus and Mycobacterium chelonae infections.J. Antimicrob. Chemother. 2014; 69: 1945-1953https://doi.org/10.1093/jac/dku062
- Implication of species change of nontuberculous mycobacteria during or after treatment, BMC pulm med 17. 213. 2017https://doi.org/10.1186/s12890-017-0539-7
- Isolation of multiple nontuberculous mycobacteria species in the same patients.Int. J. Infect. Dis. 2011; 15: e795-e798https://doi.org/10.1016/j.ijid.2011.07.004
- In Mycobacterium abscessus lung disease.Clin. Infect. Dis. 2017; 64: 309-316https://doi.org/10.1093/cid/ciw724
- Macrolide/Azalide therapy for nodular/bronchiectatic mycobacterium avium complex lung disease.Chest. 2014; 146: 276-282https://doi.org/10.1378/chest.13-2538
- Genome-wide association study of non-tuberculous mycobacterial pulmonary disease.Thorax. 2021; 76: 169-177https://doi.org/10.1136/thoraxjnl-2019-214430
- Whole genome sequencing of Nontuberculous Mycobacterium (NTM) isolates from sputum specimens of co-habiting patients with NTM pulmonary disease and NTM isolates from their environment, BMC Genomics.21. 2020; 322https://doi.org/10.1186/s12864-020-6738-2
- Man-made and natural niches, front microbiol.9. 2018; 2029https://doi.org/10.3389/fmicb.2018.02029
Article info
Publication history
Published online: August 04, 2021
Accepted:
July 22,
2021
Received in revised form:
June 2,
2021
Received:
February 18,
2021
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
