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Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease
- Source :
- Clinical Infectious Diseases. 72:1127-1137
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
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.
- 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
Subjects
Details
- ISSN :
- 15376591 and 10584838
- Volume :
- 72
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases
- Accession number :
- edsair.doi.dedup.....0350ba24d068f76f53b81803952caaff