1. Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease
- Author
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Patricia L. Winokur, Nora Watson, Getahun Abate, Ravi P. Nayak, Shanda Phillips, Kay M. Tomashek, Jack T. Stapleton, Marcia Sokol-Anderson, Buddy Creech, Lisa A. Jackson, Nicholas A Turner, Jason E. Stout, Sharon E. Frey, Francisco Leyva, Naomi Prashad Kown, Ghina Alaaeddine, Nadine Rouphael, Joan Siegner, Edward Charbek, Aaron S. Miller, Melinda Tibbals, Elizabeth Guy, Arthur W. Baker, Greta Dahlberg, Emmanuel B. Walter, Hana M. El Sahly, Katherine Sokolow, and Nour Beydoun
- Subjects
Adult ,Lung Diseases ,Microbiology (medical) ,medicine.medical_specialty ,Mycobacterium Infections, Nontuberculous ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Ethambutol ,Retrospective Studies ,Lung ,biology ,business.industry ,Medical record ,Nontuberculous Mycobacteria ,Retrospective cohort study ,Odds ratio ,Mycobacterium avium Complex ,bacterial infections and mycoses ,biology.organism_classification ,Infectious Diseases ,medicine.anatomical_structure ,030228 respiratory system ,Amikacin ,Nontuberculous mycobacteria ,business ,medicine.drug - Abstract
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 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.
- Published
- 2020