Journal article
Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease
Clinical infectious diseases, Vol.72(7), pp.1127-1137
04/01/2021
DOI: 10.1093/cid/ciaa252
PMCID: PMC8028102
PMID: 32198521
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 < .001). Overall mortality was 15.7%.
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.
Details
- Title: Subtitle
- Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease
- Creators
- Getahun Abate - Saint Louis UniversityJack T. Stapleton - University of IowaNadine Rouphael - Emory UniversityBuddy Creech - Vanderbilt UniversityJason E. Stout - Duke UniversityHana M. El Sahly - Baylor College of MedicineLisa Jackson - Kaiser Permanente Washington Health Research InstituteFrancisco J. Leyva - National Institute of Allergy and Infectious DiseasesKay M. Tomashek - National Institute of Allergy and Infectious DiseasesMelinda Tibbals - National Institute of Allergy and Infectious DiseasesNora Watson - Emmes (United States)Aaron Miller - Saint Louis UniversityEdward Charbek - Saint Louis UniversityJoan Siegner - Saint Louis UniversityMarcia Sokol-Anderson - Saint Louis UniversityRavi Nayak - Saint Louis UniversityGreta Dahlberg - University of IowaPat Winokur - Univ Iowa, Dept Internal Med, Iowa City, IA 52242 USAGhina Alaaeddine - Emory UniversityNour Beydoun - Emory UniversityKatherine Sokolow - Vanderbilt UniversityNaomi Prashad Kown - Vanderbilt UniversityShanda Phillips - Vanderbilt UniversityArthur W. Baker - Duke UniversityNicholas Turner - Duke UniversityEmmanuel Walter - Duke UniversityElizabeth Guy - Baylor College of MedicineSharon Frey - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.72(7), pp.1127-1137
- DOI
- 10.1093/cid/ciaa252
- PMID
- 32198521
- PMCID
- PMC8028102
- NLM abbreviation
- Clin Infect Dis
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Publisher
- Oxford Univ Press
- Number of pages
- 11
- Grant note
- HHSN272201300021I; HHSN272201300018I; HHSN272201300020I; HHSN272201300015I; HHSN272201300017I; HHSN272201300023I; HHSN272201300019I / National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health HSN272201500002C / Emmes Corporation
- Language
- English
- Date published
- 04/01/2021
- Academic Unit
- Microbiology and Immunology; Infectious Diseases; Medicine Administration; Internal Medicine
- Record Identifier
- 9984297424902771
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