Non-tuberculous mycobacterial lung disease in patients with bronchiectasis: perceived risk, severity and guideline adherence in a European physician survey

Abstract

BackgroundPatients with bronchiectasis are at increased risk of developing non-tuberculous mycobacteria lung disease (NTM-LD), and published guidelines recommend regular testing for NTM infection in this patient population.ObjectiveThis study aimed to survey physicians managing patients with bronchiectasis to understand the perceived risk of NTM to their patients, perceived disease severity and frequency of testing for NTM.MethodsThe study comprised an online survey of hospital-based physicians in the UK, Germany, Italy, France and the Netherlands. The target group were hospital-based physicians who had managed at least 10 adult patients with bronchiectasis over the preceding 12 months.ResultsIn total, 280 physicians completed the survey. Most (87%) thought their patients to be at particular risk of NTM, although it was perceived as a moderate risk versus other respiratory pathogens. Most perceived NTM-LD to impact patient morbidity (84%), and 61% indicated that NTM-LD significantly impacted mortality. 68% of all respondents did not test for NTM prior to initiating macrolide monotherapy, despite guidelines recommending testing. The perceived risk of and screening for NTM varied among countries.ConclusionsThe study demonstrates that physicians understand the risk of NTM-LD and associated morbidity in patients with bronchiectasis; however, a minority do not perceive that NTM-LD significantly affects mortality. Greater awareness of the need to test for NTM infection before initiating macrolide monotherapy for bronchiectasis is essential due to potential emergence of drug-resistant NTM.

A novel DNA chromatography method to discriminate Mycobacterium abscessus subspecies and macrolide susceptibility

“…MABC is the most frequent clinical isolate of rapidly growing mycobacteria and an increased emergence has recently been observed in Japan and other developed countries [42] , [43] , [44] . Commercially available DNA-DNA hybridization kits or MALDI-TOF MS are available in clinical laboratories in Japan and Taiwan to identify mycobacterium isolates [ 45 , 46 ], but they cannot discriminate between either subspecies or the macrolide-susceptible erm (41) truncation and T28C polymorphism [47] .…”

Computed Tomography in Adults with Bronchiectasis and Nontuberculous Mycobacterial Pulmonary Disease: Typical Imaging Findings

“…A minimum bundle of aetiological tests in adults with a recent diagnosis of bronchiectasis is suggested in the European Respiratory Society (ERS) guidelines for management of adult bronchiectasis, along with identification of defined aetiologies, resulting in targeted therapeutic interventions such as immunoglobulin replacement, corticosteroids, and/or antifungal or antibiotic treatment [ 13 ]. The NTM-Network European Trials group (NTM-NET) recently called for greater awareness regarding the need for NTM screening in patients with bronchiectasis [ 12 ], especially regarding the improvement of NTM screening prior to the initiation of macrolide maintenance therapy. Despite its benefits, this long-term therapy may increase the risk of macrolide resistant NTM without appropriate sputum before initiating the therapy.…”

“…Among patients with bronchiectasis, NTM-PD ranged between 1 and 6% with higher rates in the US bronchiectasis registry [ 8 , 9 , 10 ], and it is assumed that the prevalence is severely underestimated [ 11 ]. In particular, patients with bronchiectasis have been found to have a substantially increased risk of NTM-PD; however, there is still a need to improve awareness among physicians treating patients with bronchiectasis [ 12 ].…”

“…The question is, how do you identify patients with previously unrecognized NTM-PD? A survey among physicians managing patients with bronchiectasis showed that NTM testing needs to be improved, in particular with regard to NTM screening prior to the initiation of macrolide maintenance therapy [ 12 ].…”

European Respiratory Society International Congress, Madrid, 2019: nontuberculous mycobacterial pulmonary disease highlights

“…Despite European efforts to increase awareness of NTM and to improve treatment in line with guideline recommendations, there is still some way to go. Even in 2020, a survey by NTM-NET [ 57 ] has shown that patients with bronchiectasis (those at highest risk of contracting NTM [ 58 , 59 ]) are not being routinely tested for NTM; this includes patients being considered for macrolide monotherapy, despite strong recommendations from 2020 guidelines that NTM testing should be conducted before treatment initiation [60]. Importantly, among surveyed clinicians there was relatively high (>60%) understanding of the mortality and morbidity burden of NTM.…”