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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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.
