Impact of Treatment on Long-Term Survival of Patients With Mycobacterium avium Complex Pulmonary Disease

Abstract

Background Whether antimicrobial treatment improves long-term survival in patients with Mycobacterium avium complex pulmonary disease (MAC-PD) is unclear. Methods We analyzed survival of patients aged ≥18 years who were treated for MAC-PD at a tertiary referral center in South Korea between January 1, 2009 and December 31, 2020. Treatment exposure was divided into four-time intervals: <6 months, ≥6 to <12 months, ≥12 to <18 months, and ≥18 months. Time-varying multivariable Cox proportional hazards models were used to calculate the risk of all-cause mortality in each time interval. The model was adjusted for major clinical factors related to mortality including age, sex, body mass index, presence of cavities, erythrocyte sedimentation rate, positive acid-fast bacilli (AFB) smear, clarithromycin resistance, and comorbidities. Results A total of 486 patients treated for MAC-PD were included in the analysis. A significant inverse correlation was observed between mortality and duration of treatment (P for trend = 0.007). Patients treated for ≥18 months were significantly associated with reduced mortality [adjusted hazard ratio (aHR) 0.32, 95% confidence interval (CI) 0.15–0.71]. In subgroup analyses, patients with cavitary lesions (aHR 0.17, 95% CI 0.05–0.57) or positive AFB smears (aHR 0.13, 95% CI 0.02–0.84) at baseline maintained this significant inverse relationship between treatment duration and mortality. Conclusions Long-term antimicrobial treatment should be actively considered in patients with progressive MAC-PD, especially in the presence of cavities or positive AFB smears indicative of high mycobacterial burden.

Clinical characteristics of patients with non-tuberculous mycobacterial pulmonary disease: a seven-year follow-up study conducted in a certain tertiary hospital in Beijing

“…Patients with NTM-PD with cavitary lesions require prolonged and intensive therapy. Analyzing the location, size, number, and luminal wall thickness of cavitary lesions is critical for determining the prognosis of the disease and the need for additional surgical intervention ( Jhun et al., 2020 ; Kim et al., 2023a ). As a result, extensively studying the imaging features of bronchiectasis, thin-walled cavities, and solid lesions is crucial for early detection, diagnosis, treatment, and prognosis of NTM-PD.…”

Evaluation of nucleotide MALDI-TOF MS on bronchoalveolar lavage fluid for pulmonary Tuberculosis: experience from a tertiary hospital in southwestern China

“…Smear microscopy provides the advantage of speed, yet its sensitivity is insu cient nor can it differentiate MTB and nontuberculous mycobacteria (NTM). The culture method, including Mycobacterium Growth Indicator Tube 960 culture (MGIT 960 culture), remains the gold standard for the diagnosis of TB, but it demands high-level biosafety, high personnel expertise, poses risks of fragile contamination and most importantly has long turnaround time 7 , resulting the delayed diagnosis and potential drug resistance 8 . With the development of molecular technology, many methods for the rapid diagnosis of TB occur recent years, several of which have been recommended by the World Health Organization (WHO), like Xpert MTB/RIF assay, the rst approved one 9 .…”