Epidemiology of Nontuberculous Mycobacterial Infections and Associated Chronic Macrolide Use among Persons with Cystic Fibrosis

Binder, Alison M.; Adjemian, Jennifer; Olivier, Kenneth N.; Prevots, D. Rebecca

doi:10.1164/rccm.201307-1200oc

Cited by 125 publications

(104 citation statements)

References 23 publications

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“…6,500 patients with CF and negative AFB cultures before entry, 191 patients had fi rst positive NTM cultures during the study for either MAC or M abscessus and were deemed incident cases. 59 These patients were signifi cantly less likely to have used azithromycin before their NTM diagnosis, and patients with the longest azithromycin use were least likely to have PNTM. For now, however, patients considered for long-term macrolide monotherapy (eg, those with CF) should be screened to exclude PNTM before starting therapy.…”

Section: Choice Of Macrolidementioning

confidence: 93%

Pulmonary Disease Due to Nontuberculous Mycobacteria

McShane

Glassroth

2015

Chest

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Section: Choice Of Macrolidementioning

confidence: 93%

Pulmonary Disease Due to Nontuberculous Mycobacteria

McShane

Glassroth

2015

Chest

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“…88,89 There are conflicting data regarding the potential for higher nontuberculous mycobacterial infection rates in individuals with CF on chronic azithromycin. 60, [90][91][92] There is insufficient evidence to recommend for or against the chronic use of azithromycin in preschoolers with CF. …”

Section: Azithromycinmentioning

confidence: 99%

Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis

et al. 2016

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Cystic fibrosis (CF) clinical care guidelines exist for the care of infants up to age 2 years and for individuals ≥6 years of age. An important gap exists for preschool children between the ages of 2 and 5 years. This period marks a time of growth and development that is critical to achieve optimal nutritional status and maintain lung health. Given that disease often progresses in a clinically silent manner, objective and sensitive tools that detect and track early disease are important in this age group. Several challenges exist that may impede the delivery of care for these children, including adherence to therapies. A multidisciplinary committee was convened by the CF Foundation to develop comprehensive evidence-based and consensus recommendations for the care of preschool children, ages 2 to 5 years, with CF. This document includes recommendations in the following areas: routine surveillance for pulmonary disease, therapeutics, and nutritional and gastrointestinal care.

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“…Azithromycin use has recently been shown to block autophagy, suggesting that it has the potential to predispose patients with CF to mycobacterial infection (39), although this effect has not been seen in case-control studies (29,40). In addition, a recent nested case-control study by Binder and colleagues showed that patients with CF with incident NTM infections were less likely to have had chronic azithromycin treatment in the last year (41). Azithromycin was used in about one third of our subjects equally across the three outcome groups and was not associated with worse clinical outcomes.…”

Section: Original Researchmentioning

confidence: 99%

Clinical Significance of a First Positive Nontuberculous Mycobacteria Culture in Cystic Fibrosis

et al. 2014

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Rationale: Little is known about outcomes of infection with nontuberculous mycobacteria (NTM) in cystic fibrosis (CF) or about the significance of a positive NTM culture. Determining which patients are at risk for active NTM disease is clinically valuable.Objectives: To examine the clinical course of subjects with CF with an initial positive NTM culture and identify characteristics associated with active NTM disease.Methods: We performed a retrospective study of pediatric and adult subjects with CF with at least one positive NTM culture at the Colorado CF Center from 2000 to 2010.Measurements and Main Results: Mycobacterium avium complex was the first identified NTM in the majority of subjects (73%). The frequency of growing a second NTM species was 26% at 5 years. Clinical characteristics and distribution of NTM species between pediatric and adult subjects were similar except for differences in baseline FEV 1 (89% vs. 71%; P , 0.001) and coinfection with Pseudomonas aeruginosa (33% vs. 55%; P = 0.04). Over 60% of subjects had transient or persistent infection but not active NTM disease. Subjects who developed active NTM disease were distinguished from those with transient or persistent infection, respectively, by FEV 1 at the time of first positive NTM culture (72% vs. 84 or 86%; P = 0.02) and FEV 1 decline in the prior year (25.8%/yr vs. 20.7%/yr [P = 0.009] or 20.4%/yr [P = 0.001]). Conclusions:The majority of patients with CF with a first positive NTM culture do not progress to active disease. Lower lung function and accelerated lung function decline appear to be indicators of the significance of an initial positive NTM culture.

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Epidemiology of Nontuberculous Mycobacterial Infections and Associated Chronic Macrolide Use among Persons with Cystic Fibrosis

Cited by 125 publications

References 23 publications

Pulmonary Disease Due to Nontuberculous Mycobacteria

Pulmonary Disease Due to Nontuberculous Mycobacteria

Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis

Clinical Significance of a First Positive Nontuberculous Mycobacteria Culture in Cystic Fibrosis

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