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Kang N, Jhun BW. Long-term Outcomes of Adjunctive Lung Resection for Nontuberculous Mycobacteria Pulmonary Disease. Open Forum Infect Dis 2024; 11:ofae345. [PMID: 38966854 PMCID: PMC11222975 DOI: 10.1093/ofid/ofae345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
Background Adjunctive lung resection is recommended for select patients with nontuberculous mycobacteria (NTM) pulmonary disease (PD). However, data are limited on long-term recurrence rates in patients infected with major pathogens, including Mycobacterium avium complex (MAC) and Mycobacterium abscessus (MABC). Methods In this prospective observational study, we retrospectively analyzed data from 125 patients with MAC-PD (n = 90) or MABC-PD (n = 35) who underwent adjunctive lung resection. We evaluated microbiological response, postoperative complications, recurrence, and all-cause mortality over a median 80-month follow-up. Results Persistent culture positivity (64%) was the most common indication for surgery, followed by hemoptysis, recurrent pneumonia, or radiologic deterioration. Postoperative complications occurred in 18 (14%) patients, with no surgery-related deaths. Treatment outcomes did not significantly differ between the MAC- and MABC-PD groups. Cure with culture conversion was achieved in 112 (90%) patients. Recurrence occurred in 37 (33%) of 112 patients, of which 18 (49%) cases were attributed to reinfection by different NTM species or subspecies. The MAC group had higher recurrence rates than the MABC group (Kaplan-Meier curve, log-rank test, P = .043) and was significantly associated with recurrence in the multivariable analysis (adjusted hazard ratio, 2.71; 95% CI, 1.23-5.99). However, mortality was higher in the MABC-PD group than the MAC-PD group (7/35 vs 4/90, P = .006). Conclusions Adjunctive lung resection with antibiotics helps to reduce bacterial burden and manage symptoms in patients with NTM-PD. However, it does not prevent recurrence, which is mostly caused by reinfection.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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2
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Kim JY, Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Park SI, Kim DK. Adjuvant surgical resection for nontuberculous mycobacterial pulmonary disease: Effectiveness and complications. Ann Thorac Med 2024; 19:131-138. [PMID: 38766373 PMCID: PMC11100472 DOI: 10.4103/atm.atm_237_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Standard antibiotic treatment for nontuberculous mycobacteria pulmonary disease (NTMPD) has unsatisfactory success rates. Pulmonary resection is considered adjunctive therapy for patients with refractory disease or severe complications, but surgical indications and extent of resection remain unclear. We present surgical treatment outcomes for NTMPD and analyzes risk factors for unfavorable outcomes. METHODS We conducted a retrospective investigation of medical records for patients diagnosed with NTMPD who underwent surgical treatment at Asan Medical Center between 2007 and 2021. We analyzed clinical data including microbiological and surgical outcomes. RESULTS A total of 71 NTMPD patients underwent thoracic surgery. Negative conversion of acid-fast bacillus (AFB) culture following pulmonary resection was observed in 51 (73.9%) patients. In terms of long-term outcomes, negative conversion was sustained in 38 cases (55.1%). Mortality occurred in 7 patients who underwent pulmonary resections for NTMPD. Statistically significant associations with factors for recurrence or non-negative conversion of AFB culture were found in older age (odds ratio [OR] =1.093, 95% confidence interval [CI]: 1.029-1.161, P = 0.004), male sex (OR = 0.251, 95% CI: 0.071-0.892, P = 0.033), and extensive NTMPD lesions involving three lobes or more (OR = 5.362, 95% CI: 1.315-21.857, P = 0.019). Interstitial lung disease (OR = 13.111, 95% CI: 1.554-110.585, P = 0.018) and pneumonectomy (OR = 19.667, 95% CI: 2.017-191.797, P = 0.018) were statistically significant risk factors for postoperative mortality. CONCLUSION Pulmonary resection can be an effective adjuvant treatment option for NTMPD patients, with post-operative antibiotic treatment as the primary treatment. Careful patient selection is crucial, considering the associated risk factors and resectability due to complications and recurrence.
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Affiliation(s)
- Ji Yong Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Geon Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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3
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Holt MR, Baird T. Treatment Approaches to Mycobacterium abscessus Pulmonary Disease. Clin Chest Med 2023; 44:785-798. [PMID: 37890916 DOI: 10.1016/j.ccm.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Mycobacterium abscessus pulmonary disease is highly antibiotic-resistant, and the current armamentarium of antibiotics yields poor treatment outcomes with significant drug toxicity. Macrolide susceptibility is a key prognostic factor. Optimal drug combinations, duration of therapy, and management of refractory disease are unknown. Surgical resection, performed at centers with experience in surgical management of nontuberculous mycobacterial pulmonary disease, may produce favorable outcomes in select patients. Multiple emerging therapeutic candidates hold promise for more efficacious and tolerable treatment options.
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Affiliation(s)
- Michael R Holt
- Gallipoli Medical Research Foundation, The University of Queensland, Brisbane, Queensland, Australia; Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland, Australia.
| | - Timothy Baird
- Sunshine Coast Health Institute, Sunshine Coast, Queensland, Australia; University of the Sunshine Coast, Sunshine Coast, Queensland, Australia; Department of Respiratory Medicine, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Sunshine Coast, Queensland 4575, Australia
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4
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Chiang PC, Lin CY, Hsu YC, Huang LT, Chung TJ, Liu YS, Chang CC. Early drainage reduces the length of hospital stay in patients with lung abscess. Front Med (Lausanne) 2023; 10:1206419. [PMID: 37731714 PMCID: PMC10508285 DOI: 10.3389/fmed.2023.1206419] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background Although percutaneous transthoracic catheter drainage (PCD) has been proven effective in lung abscesses, the optimal timing of PCD is still unclear. The study aimed to evaluate the safety and efficacy of early versus delayed drainage in patients with lung abscesses. Methods This retrospective study included 103 consecutive patients with liquefied lung abscesses more than 3 cm confirmed by a CT scan received CT-guided PCD over 16 years, from July 2005 to September 2021, in a single institution were reviewed. Early drainage was defined as PCD within one week after a lung abscess was diagnosed. The primary outcome was 90-day mortality. The secondary outcomes included perioperative complications and patients' length of hospital stay (LoS). Factors associated with 90-day mortality and LoS were also analyzed. The key statistical methods were Chi-square test, Fisher's exact test, Student t-test, and Pearson correlation. Results Amount the 103 patients, there were 64 patients who received early PCD, and 39 patients received delayed PCD. Between the two groups, there were no significant differences in clinical characteristics, 90-day mortality, or perioperative complications. The LoS was significantly shortened in early PCD group (28.6 ± 25.5 vs. 39.3 ± 26.8 (days), p = 0.045). Higher Charlson comorbidity index, secondary lung abscess, and liver cirrhosis were associated with higher mortality (all p < 0.05). Positive sputum culture significantly increased the LoS (coefficient 19.35 (10.19, 28.50), p < 0.001). Conclusion The 90-day mortality and complications were similar for early PCD and delayed PCD patients, but LoS was significantly shortened in early PCD patient.
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Affiliation(s)
- Po-Chang Chiang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Chun Hsu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Jung Chung
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Department of Surgery, Division of Thoracic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kim JY, Lee HW, Yim JJ, Kwak N. Outcomes of Adjunctive Surgery in Patients With Nontuberculous Mycobacterial Pulmonary Disease: A Systematic Review and Meta-analysis. Chest 2022; 163:763-777. [PMID: 36208713 DOI: 10.1016/j.chest.2022.09.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/17/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The burden of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. Amidst the poor treatment success of antibiotic therapy, adjunctive surgery is gaining attention; however, discrepancies in reported outcomes exist. RESEARCH QUESTION What are the treatment outcomes and complications of patients with NTM-PD undergoing adjunctive surgery? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cochrane databases were searched for eligible studies before January 2022. Studies reporting the outcomes of adjunctive surgery in adult patients who satisfied the diagnostic criteria for NTM-PD were included. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by two independent observers. Estimates of proportion were pooled using a random-effects model. Sputum mycobacterial culture negative conversion, recurrence, complications, and in-hospital mortality after surgery were primary outcomes that had been set before data collection began. Heterogeneity was evaluated by using the I2 statistic, and publication bias was assessed by using funnel plots and the Egger test. RESULTS Fifteen of the 2,739 screened studies, with 1,071 patients, were assessed. The weighted proportion of postoperative sputum culture negative conversion was 93% (95% CI, 87%-97%), and recurrence was 9% (95% CI, 6%-14%) for a median follow-up of 34 months. The proportion of patients who experienced postoperative complications was 17% (95% CI, 13%-23%), and in-hospital mortality was 0% (95% CI, 0%-2%). Studies that performed multilobar lung resection in > 30% of the study population showed comparable rates of complications with studies that did not. INTERPRETATION Adjunctive surgery is an effective therapeutic option with acceptable rates of complications for selected patients with NTM-PD. TRIAL REGISTRY PROSPERO; No.: CRD42022310663; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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6
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Non-tuberculous mycobacteria pulmonary disease: A review of trends, risk factors, diagnosis and management. Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i2.157. [PMID: 36034054 PMCID: PMC9394508 DOI: 10.7196/ajtccm.2022.v28i2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/08/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) reports have been on the rise globally, with increasing incidence and prevalence accompanied by poor outcomes. The rise has been attributed to an ageing population with increasing comorbid illnesses, and improved laboratory techniques in diagnosing the disease. However, despite the increase, some parts of the world still lack data, especially sub-Saharan African countries. The lack of data in our setting is difficult to explain, as we have a significant burden of NTM risk factors (i.e. HIV, tuberculosis and bronchiectasis). This review therefore serves as a reminder and a challenge to start searching, and reporting on our experiences. The review will highlight the rising incidence, important risk factors, diagnosis and management of NTM pulmonary disease.
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7
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Giller DB, Shcherbakova GV, Gerasimov AN, Smerdin SV, Martel II, Kesaev OS, Koroev VV, Severova LP. Surgical Treatment of Nontuberculous Mycobacterial Pulmonary Disease and a Combination of Nontuberculous Mycobacterium Pulmonary Disease and Pulmonary Tuberculosis. Int J Infect Dis 2022; 120:12-21. [PMID: 35398593 DOI: 10.1016/j.ijid.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Nontuberculous mycobacterial pulmonary disease (NTMPD) is an important health system problem worldwide. Surgical treatment experience is limited, and the safety of such operations is still unclarified. Therefore, improving our knowledge of NTMPD is important. DESIGN In this retrospective observational study, we analyzed the medical records of 2,432 patients operated on from January 2011 through December 2017 in our hospital. There were 20 patients with NTMPD in group 1 and 23 patients with combined NTMPD and pulmonary tuberculosis in group 2. Patients received antibiotic treatment before and after surgery as per Russian Federal clinical guidelines and individual drug susceptibility. RESULTS Postoperative complications occurred in 2 (10%) cases in group 1 and 4 (17.4%) in group 2, and intraoperative complications occurred in 2 (8.7%) cases in group 2. There was no 30-day mortality in both groups. After 1 year, all 40 traced patients had neither bacterial excretion nor cavities in the lungs. After 3 years and 5 years, the efficacy among 32 and 13 traced patients was 100%, respectively. CONCLUSIONS Modern surgery for small NTMPD forms is safe - helping improve outcomes for ineffective antibiotic treatment. Combined surgery and antibiotic treatment are acceptable in both the short and long term.
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Affiliation(s)
- Dmitry Borisivich Giller
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
| | - Galina Vladimirovna Shcherbakova
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
| | - Andrey Nikolaevich Gerasimov
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
| | - Sergey Viktorovich Smerdin
- State Budgetary Healthcare Institution of the Moscow Region "Moscow Regional Clinical Anti-Tuberculosis Dispensary", 170555, Russian Federation, Moscow Region, Shchelkovsky district, Sukmanikha village, possession 1 B..
| | - Ivan Ivanovich Martel
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
| | - Oleg Schamilevich Kesaev
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
| | - Vadim Valerievich Koroev
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
| | - Lyudmila Petrovna Severova
- Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya St. bldg. 8\2, Moscow, 119435, Russian Federation.
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8
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Meldrum OW, Belchamber KB, Chichirelo-Konstantynovych KD, Horton KL, Konstantynovych TV, Long MB, McDonnell MJ, Perea L, Garcia-Basteiro AL, Loebinger MR, Duarte R, Keir HR. ERS International Congress 2021: highlights from the Respiratory Infections Assembly. ERJ Open Res 2022; 8:00642-2021. [PMID: 35615420 PMCID: PMC9124871 DOI: 10.1183/23120541.00642-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
The European Respiratory Society International Congress 2021 took place virtually for the second year running due to the coronavirus pandemic. The Congress programme featured more than 400 sessions and 3000 abstract presentations, covering the entire field of respiratory science and medicine. In this article, early career members of the Respiratory Infections Assembly summarise a selection of sessions across a broad range of topics, including presentations on bronchiectasis, non-tuberculosis mycobacteria, tuberculosis, cystic fibrosis and COVID-19.
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Affiliation(s)
- Oliver W. Meldrum
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Katie L. Horton
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Academic Unit of Clinical and Experimental Medicine, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Merete B. Long
- Division of Molecular and Clinical Medicine, Medical School, University of Dundee, Dundee, UK
| | - Melissa J. McDonnell
- Galway University Hospitals and National University of Ireland (NUIG), Galway, Ireland
| | | | - Alberto L. Garcia-Basteiro
- ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saude de Manhiça, Maputo, Mozambique
| | - Michael R. Loebinger
- Host Defence Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raquel Duarte
- Pulmonology Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Holly R. Keir
- Division of Molecular and Clinical Medicine, Medical School, University of Dundee, Dundee, UK
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10
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Kim JY, Park S, Park IK, Kang CH, Kim YT, Koh J, Yim JJ, Kwak N. Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease. BMC Pulm Med 2021; 21:312. [PMID: 34615499 PMCID: PMC8496107 DOI: 10.1186/s12890-021-01679-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Owing to the unsatisfactory results of antibiotic treatment alone, surgical resection is currently considered as adjunctive therapy in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, reports regarding the outcomes of surgery vary considerably by institution. Here, we investigated the surgical outcomes and risk factors associated with unfavorable outcomes after surgery. Methods
We analyzed patients with NTM-PD who underwent pulmonary resection at Seoul National University Hospital between January 1, 2006, and December 31, 2020, and assessed the types of surgical procedures, complications, and long-term outcomes. Multivariate logistic regression analysis was used to identify the risk factors associated with treatment refractoriness or recurrence after surgery. Results Among 67 patients who underwent surgery during the study period, the most common indication for surgery was persistent culture positivity despite rigorous medical treatment (80.6%), followed by longstanding cavitary lesions or radiographic aggravation (10.4%) and massive hemoptysis (4.5%). Among 53 patients with positive mycobacterial cultures at the time of surgery, 38 (71.7%) achieved initial negative culture conversion, 9 (17.0%) of whom experienced recurrence. Nine (13.4%) patients experienced postoperative complications, which were managed without lasting morbidity and mortality. Female sex (adjusted odds ratio [aOR] 6.63; 95% confidence interval [CI] 1.04–42.4; P = .046), preoperative positive mycobacterial culture (aOR 5.87; 95 %CI 1.04–33.08; P = .045), and residual lesions (aOR 6.86; 95 %CI 1.49–31.56; P = .013) were associated with refractoriness or recurrence. Conclusions Pulmonary resection is a reasonable treatment modality for patients with refractory NTM-PD or major complications such as massive hemoptysis. The potential risk factors associated with unfavorable outcomes included female sex, preoperative positive mycobacterial culture, and residual lesions after surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01679-0.
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Affiliation(s)
- Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jaemoon Koh
- Department of Pathology, Seoul National University Hospital, Seoul, South Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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11
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Togo T, Atsumi J, Hiramatsu M, Shimoda K, Morimoto K, Shiraishi Y. Outcomes of Surgical Treatment for Mycobacterium abscessus Complex Pulmonary Disease. Ann Thorac Surg 2021; 113:949-956. [PMID: 33839127 DOI: 10.1016/j.athoracsur.2021.03.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mycobacterium abscessus complex pulmonary disease is notoriously difficult to treat by medication alone. We report our experience with resectional surgery combined with pre- and postoperative multidrug chemotherapy for the treatment of patients with Mycobacterium abscessus complex pulmonary disease. METHODS This is a retrospective review of 33 patients undergoing lung resection for Mycobacterium abscessus complex pulmonary disease at a single center in Japan between January 2008 and December 2019. RESULTS The median age of patients was 54.0 (interquartile range, 49.0-66.0) years; 27 were females (81.8%). Nodular-bronchiectatic was the most common disease type (n=24; 72.7%). Disease was limited in 18 (54.5%) patients and extensive in 15 (45.5%). The median duration of preoperative multidrug chemotherapy employing oral and parenteral antibiotics was 10.0 (interquartile range, 3.0-18.0) months. A total of 34 anatomical lung resections were performed as follows: 22 lobectomies, 5 segmentectomies, 4 combined resections, 2 bilobectomies, and 1 pneumonectomy. No operative mortalities and 4 morbidities occurred (13.3%). The median duration of multidrug chemotherapy after the surgery was 18.0 (interquartile range, 12.0-31.0) months. Postoperative sputum-negative status was achieved in 31 patients (93.9%); all 23 patients obtaining preoperative negative conversion remained negative, and 8 of 10 patients with preoperative positive sputum became negative (80.0%) postoperatively. Recurrence was observed in 2 patients (6.5%). The recurrence-free probabilities were 96.3%, 96.3%, and 80.2% at 1, 3, and 5 years, respectively. CONCLUSIONS Combined with pre- and postoperative multidrug chemotherapy, resectional surgery can be performed safely and achieve favorable outcomes for patients with Mycobacterium abscessus complex pulmonary disease.
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Affiliation(s)
- Takeo Togo
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan.
| | - Jun Atsumi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Miyako Hiramatsu
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Kiyomi Shimoda
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Kozo Morimoto
- Section of Respiratory Medicine, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Yuji Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
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12
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Sekihara K, Hirai H, Sumiya R, Momose N, Sugimura A, Nagasaka S. Thoracoscopic right middle lobectomy for Mycobacterium abscessus in a young patient suspected of having congenital immunodeficiency. Asian J Endosc Surg 2021; 14:112-115. [PMID: 32776415 DOI: 10.1111/ases.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
Mycobacterium abscessus (M. abscessus) infection is resistant to multi-antibacterial treatment, and surgical resection is often recommended. We report a case of M. abscessus infection in a young patient suspected of having a GATA2 mutation. A 19-year-old woman with a medical history of severe sinusitis and a family history of non-tuberculous mycobacteriosis presented at our hospital. M. abscessus was confirmed by sputum culture. The patient received multidrug therapy, including clarithromycin. CT scan demonstrated bronchodilation and capacity decrease due to non-obstructive atelectasis in the middle lobe. We performed thoracoscopic resection without complications. Congenital immunodeficiency was suspected given the patient's past medical and family history. The result of lymphocyte subset analysis revealed a GATA2 mutation, but no genetic mutation was detected by a next-generation sequencer. The patient followed a good clinical course. This paper reports the successful treatment of an M. abscessus infection and the importance of checking the genetic background of young patients.
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Affiliation(s)
- Keigo Sekihara
- Division of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hoshie Hirai
- Division of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryusuke Sumiya
- Division of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naoya Momose
- Division of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aya Sugimura
- Division of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Nagasaka
- Division of Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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13
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Terada K, Yan T, Mugishima K, Kawasaki S, Itagaki F, Yamada T, Sakai Y. Improvement of multiple intraperitoneal nodules resembling peritoneal cancer that developed after peritoneal dialysis-related peritonitis caused by Mycobacterium abscessus with literature review: granuloma or carcinoma. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Peritonitis is a crucial complication that leads to hospitalization or even death in patients who are undergoing peritoneal dialysis (PD). The incidence of PD-related peritonitis associated with nontuberculous mycobacteria has increased in recent years. However, a well-established treatment for peritonitis is lacking, particularly in peritonitis caused by Mycobacterium abscessus which is a difficult to treat disease due to its inherent resistance to majority of available antibiotics. To the best of our knowledge, this case is the first to report on intraperitoneal multiple nodules that developed due to PD-related peritonitis caused by M. abscessus.
Case presentation
This case reported a case of a 40-year-old female patient who was undergoing PD and who showed multiple intraperitoneal nodules that resembled peritoneal cancer on computed tomography (CT) and that developed after PD-related peritonitis and catheter removal. After multiantibiotic therapy, multiple nodules were found to have disappeared on CT. The nodules continued to disappear and the patient did not show signs of recurrent peritonitis, although there was a possibility of recurrence.
Conclusion
To the best of our knowledge, this case is the first to report on nodules that resembled peritoneal cancer and that developed in the abdominal cavity due to PD-related peritonitis caused by M. abscessus. Positron emission tomography–CT was not useful in distinguishing peritoneal cancer from nodules caused by M. abscessus.
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14
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Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis 2020; 71:e1-e36. [PMID: 32628747 PMCID: PMC7768748 DOI: 10.1093/cid/ciaa241] [Citation(s) in RCA: 382] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
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Affiliation(s)
- Charles L Daley
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan M Iaccarino
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
- German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Emmanuelle Cambau
- National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France
| | - Richard J Wallace
- Mycobacteria/Nocardia Laboratory, Department of Microbiology, The University of Texas Health Science Center, Tyler, Texas, USA
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France
- EA 4294, AGIR, Jules Verne Picardy University, Amiens, France
| | - Erik C Böttger
- Institute of Medical Microbiology, National Reference Center for Mycobacteria, University of Zurich, Zurich, Switzerland
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | - David E Griffith
- Pulmonary Infectious Disease Section, University of Texas Health Science Center, Tyler, Texas, USA
| | - Lorenzo Guglielmetti
- National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France
- Team E13 (Bactériologie), Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, Université Pierre et Marie Curie, Université Paris 06, Centre de Recherche 7, INSERM, IAME UMR1137, Paris, France
| | - Gwen A Huitt
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado, USA
| | | | - Theodore K Marras
- Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Kenneth N Olivier
- Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jason E Stout
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kevin L Winthrop
- Divisions of Infectious Diseases, Schools of Public Health and Medicine, Oregon Health and Science University, Portland, Oregon, USA
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15
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To K, Cao R, Yegiazaryan A, Owens J, Venketaraman V. General Overview of Nontuberculous Mycobacteria Opportunistic Pathogens: Mycobacterium avium and Mycobacterium abscessus. J Clin Med 2020; 9:E2541. [PMID: 32781595 PMCID: PMC7463534 DOI: 10.3390/jcm9082541] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) are emerging human pathogens, causing a wide range of clinical diseases affecting individuals who are immunocompromised and who have underlying health conditions. NTM are ubiquitous in the environment, with certain species causing opportunistic infection in humans, including Mycobacterium avium and Mycobacterium abscessus. The incidence and prevalence of NTM infections are rising globally, especially in developed countries with declining incidence rates of M. tuberculosis infection. Mycobacterium avium, a slow-growing mycobacterium, is associated with Mycobacterium avium complex (MAC) infections that can cause chronic pulmonary disease, disseminated disease, as well as lymphadenitis. M. abscessus infections are considered one of the most antibiotic-resistant mycobacteria and are associated with pulmonary disease, especially cystic fibrosis, as well as contaminated traumatic skin wounds, postsurgical soft tissue infections, and healthcare-associated infections (HAI). Clinical manifestations of diseases depend on the interaction of the host's immune response and the specific mycobacterial species. This review will give a general overview of the general characteristics, vulnerable populations most at risk, pathogenesis, treatment, and prevention for infections caused by Mycobacterium avium, in the context of MAC, and M. abscessus.
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Affiliation(s)
- Kimberly To
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (K.T.); (A.Y.)
| | - Ruoqiong Cao
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (R.C.); (J.O.)
| | - Aram Yegiazaryan
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (K.T.); (A.Y.)
| | - James Owens
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (R.C.); (J.O.)
| | - Vishwanath Venketaraman
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (R.C.); (J.O.)
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16
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Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, Böttger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J 2020; 56:2000535. [PMID: 32636299 PMCID: PMC8375621 DOI: 10.1183/13993003.00535-2020] [Citation(s) in RCA: 395] [Impact Index Per Article: 98.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022]
Abstract
Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.
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Affiliation(s)
- Charles L. Daley
- National Jewish Health and University of Colorado Health
Sciences, Denver, Colorado, USA
| | | | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center
Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Respiratory
Medicine & International Health, University of Lübeck, Lübeck,
Germany, and Dept of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Emmanuelle Cambau
- National Reference Center for Mycobacteria and
Antimycobacterial Resistance, APHP -Hôpital Lariboisière,
Bacteriology; Inserm University Paris Diderot, IAME UMR1137, Bacteriology, Paris,
France
| | - Richard J. Wallace
- Mycobacteria/Nocardia Laboratory, Dept of Microbiology, The
University of Texas Health Science Center, Tyler, TX, USA
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital
Amiens, Amiens, France and EA 4294, AGIR, Jules Verne Picardy University, Amiens,
France
| | - Erik C. Böttger
- Institute of Medical Microbiology, National Reference
Center for Mycobacteria, University of Zurich, Zurich, Switzerland
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics,
McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N
3Z5 Canada
| | - David E. Griffith
- Pulmonary Infectious Disease Section, University of Texas
Health Science Center, Tyler, TX, USA
| | - Lorenzo Guglielmetti
- National Reference Center for Mycobacteria and
Antimycobacterial Resistance, APHP -Hôpital Lariboisière,
Bacteriology; Inserm University Paris Diderot, IAME UMR1137, Bacteriology, Paris,
France
- Team E13 (Bactériologie), Centre
d’Immunologie et des Maladies Infectieuses, Sorbonne Université,
Université Pierre et Marie Curie, Université Paris 06, Centre de
Recherche 7, INSERM, IAME UMR1137, Paris, Francis
| | - Gwen A. Huitt
- Library and Knowledge Services, National Jewish Health,
Denver, Colorado, USA
| | - Shandra L. Knight
- Library and Knowledge Services, National Jewish Health,
Denver, Colorado, USA
| | | | - Theodore K. Marras
- Dept of Medicine, University of Toronto and University
Health Network, Toronto, ON, Canada
| | - Kenneth N. Olivier
- Pulmonary Branch, National Heart, Lung and Blood
Institute, Bethesda, MD, USA
| | - Miguel Santin
- Service of Infectious Diseases, Bellvitge University
Hospital-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat,
Barcelona, Spain
| | - Jason E. Stout
- Division of Infectious Diseases and International Health,
Duke University Medical Center, Durham, NC, USA
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele
Scientific Institute, Milan, Italy
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Dept of Medical
Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dirk Wagner
- Division of Infectious Diseases, Dept of Medicine II,
Medical Center - University of Freiburg, Faculty of Medicine, University of
Freiburg, Freiburg, Germany
| | - Kevin L. Winthrop
- Divisions of Infectious Diseases, Schools of Public
Health and Medicine, Oregon Health and Science University, Portland, OR, USA
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17
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Extensive Lung Resection for Nontuberculous Mycobacterial Lung Disease With Multilobar Lesions. Ann Thorac Surg 2020; 111:253-260. [PMID: 32621813 DOI: 10.1016/j.athoracsur.2020.05.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/17/2020] [Accepted: 05/08/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nontuberculous mycobacterial lung disease often spreads to multiple lobes, and extensive lung resection (ELR) is sometimes required to control the disease. The safety and feasibility of ELR for nontuberculous mycobacterial lung disease remain unclear, however. METHODS This retrospective study included patients with nontuberculous mycobacterial lung disease who underwent adjuvant lung resection. Characteristics were compared between patients who underwent ELR and those who underwent simple anatomic lung resection (SALR). The outcome data were analyzed by a Cox regression analysis. RESULTS A total of 146 patients underwent ELR (n = 54) or SALR (n = 92). ELR was associated with a longer operative time (306 vs 237 minutes; P < .001) and higher incidence of prolonged air leak (17% vs 3.3%; P = .016) than SALR. Rates of mortality, sputum culture conversion (positive to negative), and microbiological recurrence did not differ markedly between the groups. In the multivariate analysis, ELR was not a significant risk factor for an unfavorable outcome after nontuberculous mycobacterial lung disease surgery (hazard ratio, 2.23; 95% confidence interval, 0.82-6.03; P= .11). CONCLUSIONS ELR for nontuberculous mycobacterial lung disease has some drawbacks compared with SALR but seems as safe and feasible as SALR. ELR may provide improved disease control in some cases of nontuberculous mycobacterial lung disease with multilobar lesions.
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18
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The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome. Respir Res 2020; 21:153. [PMID: 32546152 PMCID: PMC7298848 DOI: 10.1186/s12931-020-01420-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been reported to be associated with favorable outcomes. However, little is known regarding the risk and prognostic factors for refractory and recurrent cases. We aimed to evaluate the overall impact and benefit of adjuvant lung surgery by comparing NTM-PD patients who underwent adjuvant lung resection with those treated exclusively with antibiotics. We also investigated the efficacy of serum IgA antibody against glycopeptidolipid (GPL) core antigen (GPL core antibody) to monitor disease activity and predict the recurrence of disease after adjuvant lung resection. METHODS We retrospectively evaluated the clinical characteristics and surgical outcomes of 35 patients surgically treated for NTM-PD. Furthermore, we compared surgically treated patients and control patients treated exclusively with antibiotics who were matched statistically 1:1 using a propensity score calculated from age, sex, body mass index, and radiologic features of disease. RESULTS In the surgically treated patients, the median age was 58 (interquartile range, 47-65) years and 65.7% were female. Twenty-eight patients had Mycobacterium avium complex. Operations comprised four pneumonectomies, two bilobectomies, one bilobectomy plus segmentectomy, 17 lobectomies, two segmentectomies, and nine lobectomies plus segmentectomies. Postoperative complications occurred in seven patients (20%), there were no operative deaths, and 33 (94.3%) patients achieved negative sputum culture conversion. Refractory and recurrent cases were associated with remnant bronchiectasis, contralateral shadows, and positive acid-fast bacilli staining or culture. Of 28 statistically matched pairs, long-term sustained negative culture conversion was observed in 23 (82.2%) surgical group patients and in 14 (50.0%) non-surgical group patients (0.0438). The mortality rate was lower in the surgical group, but did not reach statistical significance (one in the surgical group and four in the non-surgical group, p = 0.3516). GPL core antibody was correlated with disease activity and recurrence. CONCLUSIONS NTM-PD patients who underwent adjuvant lung resection experienced overall favorable outcomes and achieved sputum culture conversion more frequently. Long-term mortality may have been reduced by this procedure, and the level of GPL core antibody was shown to be a good clinical indicator of disease activity after surgery.
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19
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Recent advances and controversies in surgical intervention of nontuberculous mycobacterial lung disease: A literature review. J Formos Med Assoc 2020; 119 Suppl 1:S76-S83. [DOI: 10.1016/j.jfma.2020.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
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20
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Togo T, Atsumi J, Hiramatsu M, Shimoda K, Morimoto K, Uchimura K, Shiraishi Y. Residual Destructive Lesions and Surgical Outcome in Mycobacterium avium Complex Pulmonary Disease. Ann Thorac Surg 2020; 110:1698-1705. [PMID: 32473130 DOI: 10.1016/j.athoracsur.2020.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Successful surgical treatment of patients with Mycobacterium avium complex pulmonary disease is thought to require complete removal of parenchymal destructive lesions. This study aimed to evaluate the short-term and long-term outcomes and the predictors of microbiological recurrence after surgery for M avium complex pulmonary disease. METHODS We conducted a retrospective review of 184 patients undergoing unilateral lung resection for M avium complex pulmonary disease at a single center in Japan between January 2008 and December 2017. RESULTS Median age of the 184 patients was 55.5 years; 133 were female (72.3%). All but 2 patients had anatomical lung resection. A total of 116 patients had limited disease and underwent complete resection (63.0%); the remaining 68 patients had extensive disease and underwent debulking surgery (37.0%). No operative mortalities occurred. In 18 of 184 patients, 21 morbidities occurred (9.8%), including 3 bronchopleural fistulas (1.6%). Postoperative sputum-negative status was achieved in 183 patients (99.5%). Microbiological recurrences occurred in 15 patients (8.2%). By multivariate analysis, extensive disease was an independent risk factor for recurrence (hazard ratio, 5.432; 95% confidence interval, 1.372-21.50; P = .016). Recurrence-free rates were significantly higher in patients with limited disease compared with those with extensive disease (99.0%, 97.4%, and 95.0% versus 93.0%, 89.2%, and 75.1% at 1, 3, and 5 years, respectively; P < .001). CONCLUSIONS Complete resection of parenchymal destructive lesions can achieve excellent microbiological control for patients with limited M avium complex pulmonary disease. The efficacy of debulking surgery in patients with extensive disease needs further investigation.
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Affiliation(s)
- Takeo Togo
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan.
| | - Jun Atsumi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Miyako Hiramatsu
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Kiyomi Shimoda
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Kozo Morimoto
- Section of Respiratory Medicine, Fukujuji Hospital, Kiyose, Tokyo, Japan
| | - Kazuhiro Uchimura
- Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Yuji Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo, Japan
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21
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Nontuberculous Mycobacteria Infection: Source and Treatment. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Mycobacterium avium complex pulmonary disease: new epidemiology and management concepts. Curr Opin Infect Dis 2019; 31:199-207. [PMID: 29346118 DOI: 10.1097/qco.0000000000000437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The prevalence of Mycobacterium avium complex (MAC)-related pulmonary disease has been increasing because of environmental factors, changes in organism virulence, and evolving host susceptibility. Treatment is often complicated by adverse effects, development of drug resistance, and refractory disease, with recurrence rates as high as 25-45%. RECENT FINDINGS Aerosolization of water, soil, or dusts are the likely sources of MAC-related pulmonary disease in susceptible individuals. The management of MAC-related pulmonary disease requires a multimodality approach, including antimicrobial therapy in appropriate patients, employment of mucus clearance techniques, instituting changes in the individual's home environment and personal habits to reduce environmental exposure to MAC, prevention of reflux, and maintenance of a healthy body weight. When the standard treatment for MAC-related pulmonary disease is not possible because of drug intolerance, antibiotic resistance, or progression of disease, second-line agents such as inhaled amikacin, clofazimine, bedaquiline, and delamanid must be considered, despite limited experience and few studies to guide their use. SUMMARY Individuals who have proven to be susceptible to MAC-related pulmonary disease should institute measures to reduce exposure to environmental sources of infection. Further research is needed to assess the impact of such preventive strategies on the incidence of new infection and disease recurrence. The efficacy of new medications for MAC-related pulmonary disease and their use in different combinations also requires further study.
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23
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Kwon YS, Daley CL, Koh WJ. Managing antibiotic resistance in nontuberculous mycobacterial pulmonary disease: challenges and new approaches. Expert Rev Respir Med 2019; 13:851-861. [PMID: 31256694 DOI: 10.1080/17476348.2019.1638765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: The incidence and prevalence rates of nontuberculous mycobacterial (NTM) pulmonary disease have been continuously increasing worldwide. However, the rate of successful treatment of this disease greatly needs improving, particularly when intrinsic (natural) drug resistance and acquired drug resistance in NTM pulmonary disease are associated with poor outcomes for patients. Areas covered: This review covers the major pathogens that cause NTM pulmonary disease caused by Mycobacterium avium complex, Mycobacterium abscessus, and Mycobacterium kansasii; the key drugs and recommended regimens used in the treatment of NTM pulmonary disease; the factors that contribute to resistance to the key drugs, including genetic factors and monotherapy; and the treatment strategies, including revised antibiotic regimens and surgery, that can be used to treat drug-resistant NTM pulmonary disease. Expert opinion: To avoid and overcome drug resistance in NTM pulmonary disease, the appropriate guideline-based treatments are essential, and clinical studies to evaluate new or repurposed drugs are urgently needed.
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Affiliation(s)
- Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital , Gwangju , South Korea
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health , Denver , CO , USA
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
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24
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Nathavitharana RR, Strnad L, Lederer PA, Shah M, Hurtado RM. Top Questions in the Diagnosis and Treatment of Pulmonary M. abscessus Disease. Open Forum Infect Dis 2019; 6:ofz221. [PMID: 31289727 PMCID: PMC6608938 DOI: 10.1093/ofid/ofz221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Mycobacterium abscessus disease is particularly challenging to treat, given the intrinsic drug resistance of this species and the limited data on which recommendations are based, resulting in a greater reliance on expert opinion. We address several commonly encountered questions and management considerations regarding pulmonary Mycobacterium abscessus disease, including the role of subspecies identification, diagnostic criteria for determining disease, interpretation of drug susceptibility test results, approach to therapy including the need for parenteral antibiotics and the role for new and repurposed drugs, and the use of adjunctive strategies such as airway clearance and surgical resection.
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Affiliation(s)
- Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Luke Strnad
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
- Epidemiology Programs, Oregon Health and Sciences University and Portland State University School of Public Health, Portland, Oregon
| | - Philip A Lederer
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
- Baltimore City Health Department, Baltimore, Maryland
| | - Rocio M Hurtado
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Global Health Committee, Ethiopia and Cambodia
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Sollitto F, Ardò NP, De Bellis R, Marasco RD, Loizzi D. Extrapleural pneumonectomy in atypical mycobacteriosis: the modern use of "Sarot procedure". Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tabata E, Sekine A, Hagiwara E, Tajiri M, Ogura T. Bronchoscopy as a Useful Examination for Determining Surgical Treatment Indications in Refractory Mycobacterium avium Complex Lung Disease Patients with Bilateral Lesions. Intern Med 2019; 58:973-978. [PMID: 30449787 PMCID: PMC6478976 DOI: 10.2169/internalmedicine.1370-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We herein report three cases of refractory Mycobacterium avium complex (MAC) disease successfully treated surgically despite the MAC lesions being present bilaterally. Of note, although two patients did not present with any respiratory symptom, bronchoscopy clearly revealed a major excretory lesion with a large amount of purulent sputum in all patients. Because an excretory lesion was localized, surgical resection was performed, and the mycobacterial sputum smear became negative in all patients. Bronchoscopy may be a useful examination for detecting major excretory lesions with purulent sputum, which can disseminate to other lobes, and for determining the surgical indications of refractory MAC patients, regardless of the presence of respiratory symptoms.
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Affiliation(s)
- Erina Tabata
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Michihiko Tajiri
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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27
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Abstract
Adjuvant surgical resection in the setting of pulmonary nontuberculous mycobacterial (NTM) infection removes focal parenchymal disease thought to serve as a poorly perfused "reservoir" for organisms, thus resistant to standard antimicrobial therapy. Removal of these areas of damaged lung is felt to enhance the effectiveness of the medical treatment. In general, these operations are associated with low morbidity and mortality, although resections that are more extensive carry higher risk. Many of the planned operations may be performed with minimally invasive techniques. More data are needed regarding long-term outcomes in these patients.
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Affiliation(s)
- John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Academic Office 1, Room 6602, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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Kwon YS, Koh WJ, Daley CL. Treatment of Mycobacterium avium Complex Pulmonary Disease. Tuberc Respir Dis (Seoul) 2019; 82:15-26. [PMID: 30574687 PMCID: PMC6304322 DOI: 10.4046/trd.2018.0060] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/14/2018] [Accepted: 10/16/2018] [Indexed: 01/15/2023] Open
Abstract
The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.
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Affiliation(s)
- Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Won Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA.
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Yamada K, Seki Y, Nakagawa T, Hayashi Y, Yagi M, Ogawa K. Outcomes and risk factors after adjuvant surgical treatments for Mycobacterium avium complex lung disease. Gen Thorac Cardiovasc Surg 2018; 67:363-369. [DOI: 10.1007/s11748-018-1029-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/28/2018] [Indexed: 01/15/2023]
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Lamb GS, Starke JR. Mycobacterium abscessus Infections in Children: A Review of Current Literature. J Pediatric Infect Dis Soc 2018; 7:e131-e144. [PMID: 29897511 DOI: 10.1093/jpids/piy047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022]
Abstract
There is limited literature on Mycobacterium abscessus infections in children and limited data about its diagnosis and management. The incidence of infections due to M abscessus appears to be increasing in certain populations and can be a significant cause of morbidity and mortality.Management of these infections is challenging and relies on combination antimicrobial therapy and debridement of diseased tissue, depending on the site and extent of disease. Treatment regimens often are difficult to tolerate, and the antimicrobials used can cause significant adverse effects, particularly given the long duration of therapy needed.This review summarizes the literature and includes information from our own institution's experience on pediatric M abscessus infections including the epidemiology, transmission, clinical manifestations, and the management of these infections. Adult data have been used where there are limited pediatric data. Further studies regarding epidemiology and risk factors, clinical presentation, optimal treatment, and outcomes in children are necessary.
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Aznar ML, Zubrinic M, Siemienowicz M, Hashimoto K, Brode SK, Mehrabi M, Patsios D, Keshavjee S, Marras TK. Adjuvant lung resection in the management of nontuberculous mycobacterial lung infection: A retrospective matched cohort study. Respir Med 2018; 142:1-6. [PMID: 30170795 DOI: 10.1016/j.rmed.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/18/2018] [Accepted: 07/07/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is considered when medical therapy alone fails to provide long term control. Data regarding comparative and long-term outcomes are limited. We aimed to review indications and outcomes of adjuvant lung resection for NTM-PD compared with controls. METHODS We retrospectively studied 27 surgically treated patients, matched 1:1 for age, sex, NTM species, and radiologic pattern of disease, with control patients treated exclusively with antibiotics. RESULTS In the surgical group, the median (IQR) age was 55 (49-61) years and 74.1% were female. Eighteen patients had Mycobacterium avium complex, and 9 had M. xenopi. Operations included 8 pneumonectomies, 20 lobectomies, one segmentectomy and one lobectomy plus segmentectomy. Post-surgical complications occurred in 6 patients (20%), including 2 acute respiratory distress syndrome, 1 bronchopleural fistula, 1 pericardial tamponade, and 2 empyema. Complications were more common among patients operated upon for progressive disease despite medical therapy (OR 10, p = 0.025). Of 24 matched pairs followed for ≥1 year, sustained culture conversion was observed in 21 (87.5%) patients in the surgical group and in 11 (45.8%) patients in the non-surgical group (RR 2.36, 95%CI 1.37-4.03, p = 0.002). Median (IQR) percentage of follow-up time on antibiotics was 14% (0-100%) in the surgical group and 83% (10.8%-100%) in the non-surgical group (p = 0.195) during a median (IQR) follow-up of 16 (2-36) months. CONCLUSIONS NTM-PD patients who underwent adjuvant lung resection experienced significant morbidity and more frequently achieved sputum culture conversion. Long term antibiotic requirements may have been reduced.
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Affiliation(s)
- María Luisa Aznar
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Marijana Zubrinic
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Miranda Siemienowicz
- Joint Department of Medical Imaging, University Health Network, Women's College Hospital and Mount Sinai Hospital, Toronto, ON, Canada
| | - Kohei Hashimoto
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Sarah Kathleen Brode
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; West Park Healthcare Centre, 82 Buttonwood Ave., Toronto, ON, M6M 2J5, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Mahtab Mehrabi
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Demetris Patsios
- Joint Department of Medical Imaging, University Health Network, Women's College Hospital and Mount Sinai Hospital, Toronto, ON, Canada
| | - Shafique Keshavjee
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada
| | - Theodore Konstantine Marras
- Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
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Asakura T, Hayakawa N, Hasegawa N, Namkoong H, Takeuchi K, Suzuki S, Ishii M, Betsuyaku T, Abe Y, Ouchi M. Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease. Clin Infect Dis 2018; 65:244-251. [PMID: 28369361 DOI: 10.1093/cid/cix274] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/24/2017] [Indexed: 01/03/2023] Open
Abstract
Background Pulmonary resection along with multiple antimicrobial therapy has produced favorable outcomes at a few centers. However, little is known regarding the risk factors for long-term survival and microbiological recurrence after pulmonary resection for nontuberculous mycobacterial pulmonary disease (NTMPD). We evaluated the long-term outcomes of pulmonary resection, including microbiological recurrence and survival. Methods This retrospective cohort study included 125 patients (median age, 60 years) with NTMPD treated by pulmonary resection at two referral centers between January 1994 and August 2015. Results Postoperative complications occurred in 27 patients (22%). The complication rate after pneumonectomy was significantly higher than those after other types of pulmonary resection (odds ratio, 4.1; 95% confidence interval [CI], 1.6-10.3; P = .005). The median follow-up period was 7.1 years. While 19 patients experienced microbiological recurrence, 26 died. Multivariate analysis revealed pneumonectomy (adjusted hazard ratio [aHR], 0.12; 95% CI, .007-.66; P = .0098) and cavitary lesions after surgery (aHR, 6.73; 95% CI, 1.68-22.7; P = .0095) to be predictors of microbiological recurrence and old age (aHR, 1.06; 95% CI, 1.01-1.13; P = .016), low body mass index (BMI; aHR for every 1-kg/m2 increase, 0.72; 95% CI, .60-.85; P < .0001), pneumonectomy (aHR, 4.38; 95% CI, 1.78-11.3; P = .014), and remnant cavitary lesions (aHR, 3.53; 95% CI, 1.35-9.57; P = .011) to be predictors of poor prognosis. Conclusions Patients who could benefit from pulmonary resection should be carefully selected considering age, BMI, remnant lesions after surgery, and type of pulmonary resection.
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Affiliation(s)
- Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.,Japan Society for the Promotion of Science, Tokyo
| | | | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine.,Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Ken Takeuchi
- Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa
| | - Shoji Suzuki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
| | - Yoshiaki Abe
- Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa
| | - Motofumi Ouchi
- Department of Thoracic Surgery, Seirei Yokohama Hospital, Kanagawa
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Chalmers J, Aksamit T, Carvalho A, Rendon A, Franco I. Non-tuberculous mycobacterial pulmonary infections. Pulmonology 2018. [DOI: 10.1016/j.pulmoe.2017.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Sakane T, Matsuoka K, Kumata S, Watanabe R, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. The outcomes of anatomical lung resection for nontuberculous mycobacterial lung disease. J Thorac Dis 2018; 10:954-962. [PMID: 29607168 DOI: 10.21037/jtd.2018.01.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The number of cases of nontuberculous mycobacterial (NTM) lung disease has been increasing in recent years, and the efficacy of surgical treatment has been recognized. We investigated the clinical characteristics and behavior of NTM lung disease and analyzed the outcomes of surgery. Methods The data of 25 patients who underwent anatomical resection for NTM lung disease in our institution between January 2004 and December 2014 were retrospectively examined. Results The patients included 10 men and 15 women (mean age, 63.1 years). Twenty patients had Mycobacterium avium, and 5 had Mycobacterium intracellular. The indications for lung resection in 20 definitively diagnosed patients included a remaining or worsening lesion despite medical treatment (n=16), massive hemoptysis or bloody sputum (n=5), and prolonged smear positivity (n=1); multiple reasons were allowed. In five cases without a definitive diagnosis, surgery was performed due to the suspicion of lung cancer. The surgical procedures included pneumonectomy, n=4; lobectomy, n=13; and segmentectomy, n=8. Complete resection was achieved in 10 cases (40.0%). Video-assisted thoracoscopic surgery (VATS) was performed in 17 cases (68.0%), especially in 6 of 8 cases (75.0%) that underwent segmentectomy and in 10 of 11 cases (90.9%) that received simple lobectomy. There was one case of hospital mortality. Among the 22 patients who were followed at our institution, relapse occurred in 4 patients, and new infection occurred in 1 patient. NTM lung disease was controlled in 17 patients (77.3%). In the four cases that relapsed, the median relapse-free interval was 29.5 months. Conclusions Surgical resection was a feasible treatment for NTM lung disease and was associated with favorable outcomes, although there was 1 case of hospital mortality. VATS procedures were considered adequate for the treatment of NTM lung disease; however, the surgical indications must be carefully considered.
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Affiliation(s)
- Tadashi Sakane
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Sakiko Kumata
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Risa Watanabe
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
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Scordamaglio PR, Tedde ML, Minamoto H, Assad RS, Fernandes PMP. Can total bronchopleural fistulas from complete stump dehiscence be endoscopically treated? Eur J Cardiothorac Surg 2017; 51:702-708. [PMID: 28082466 DOI: 10.1093/ejcts/ezw377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Bronchopleural fistula (BPF) is an uncommon complication following a lung resection to address various conditions. BPFs are associated with high morbidity and mortality rates. This study evaluated the endoscopic treatment of 'total' BPFs using the Occlutech-Fígulla® cardiac device at a single centre. Methods We selected nine patients with chronic and complete BPFs. Under direct bronchoscopic visualization, the BPFs were treated using the Occlutech-Fígulla device. The patients were followed up for 12 months to determine the treatment level and complications. Results The procedure had a favourable outcome in three patients, resulting in complete fistula closure. Two patients had partial closure and showed improvements in their clinical conditions. In two other cases, closure of the bronchial stump was unsuccessful using this method. Two patients died from causes unrelated to the procedure or the device. During the follow-up period, no complications related to infection or device-related injuries were reported. Conclusions In patients without clinical conditions that require surgical treatment, the Occlutech-Fígulla cardiac device can be a safe and effective method for the endoscopic treatment of large BPFs resulting from complete dehiscence of a bronchial stump. No severe events were reported.
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Affiliation(s)
- Paulo Rogério Scordamaglio
- Division of Respiratory Endoscopy, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Hélio Minamoto
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Renato Samy Assad
- Cardiovascular Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo Fernandes
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
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Haworth CS, Banks J, Capstick T, Fisher AJ, Gorsuch T, Laurenson IF, Leitch A, Loebinger MR, Milburn HJ, Nightingale M, Ormerod P, Shingadia D, Smith D, Whitehead N, Wilson R, Floto RA. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax 2017; 72:ii1-ii64. [DOI: 10.1136/thoraxjnl-2017-210927] [Citation(s) in RCA: 351] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 01/18/2023]
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[Nontuberculous mycobacteria in sputum : Recommendations for diagnosis and treatment]. Internist (Berl) 2017; 58:1163-1170. [PMID: 29038903 DOI: 10.1007/s00108-017-0330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pulmonary diseases caused by nontuberculous mycobacteria (NTM) have increased over the last years and decades in Germany and also worldwide. Because the disease is more frequent in patients with immunodeficiencies and chronic respiratory diseases, e.g. bronchiectasis, advanced chronic obstructive lung disease (COPD) and cystic fibrosis (CF), an infection with mycobacteria should always be considered in this patient group. The detection in sputum alone is not an indication for treatment but the correct diagnosis should be based on the appropriate clinical symptoms as well as radiological and microbiological criteria. The diagnosis is often delayed because the symptoms are unspecific. The treatment of pulmonary NTM disease is difficult and tedious and for these reasons is often prematurely terminated. Adherence of treating physicians to the guidelines is also conspicuously low. Before starting treatment, it is important to carefully define the goals and clarify the risks and benefits of the treatment with the patient. As adverse toxic events can occur during treatment, it should be closely monitored. In the case of an infrequent pathogen or a severe course of the disease, referral to an NTM specialist center should be undertaken.
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38
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Sohn S, Wang S, Shi H, Park S, Lee S, Park KT. Mixed Infection of Mycobacterium abscessus subsp. abscessus and Mycobacterium tuberculosis in the Lung. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:50-53. [PMID: 28180105 PMCID: PMC5295485 DOI: 10.5090/kjtcs.2017.50.1.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022]
Abstract
A mixed infection of Mycobacterium abscessus subsp. abscessus (Mab) and Mycobacterium tuberculosis (MTB) in the lung is an unusual clinical manifestation and has not yet been reported. A 61-year-old woman had been treated for Mab lung disease and concomitant pneumonia, and was diagnosed with pulmonary tuberculosis (PTB). Despite both anti-PTB and anti-Mab therapy, her entire left lung was destroyed and collapsed. She underwent left pneumonectomy and received medical therapy. We were able to successfully treat her mixed infection by pneumonectomy followed by inhaled amikacin therapy. To the best of our knowledge, thus far, this is the first description of a mixed Mab and MTB lung infection.
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Affiliation(s)
- Sungmin Sohn
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine
| | - Sungho Wang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine
| | - Hyejin Shi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine
| | - Sungrock Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine
| | - Sangki Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine
| | - Kyoung Taek Park
- Department of Thoracic and Cardiovascular Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine
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Fleshner M, Olivier KN, Shaw PA, Adjemian J, Strollo S, Claypool RJ, Folio L, Zelazny A, Holland SM, Prevots DR. Mortality among patients with pulmonary non-tuberculous mycobacteria disease. Int J Tuberc Lung Dis 2017; 20:582-7. [PMID: 27084809 DOI: 10.5588/ijtld.15.0807] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SETTING Tertiary referral center, National Institutes of Health (NIH), USA. OBJECTIVE To estimate the mortality rate and its correlates among persons with pulmonary non-tuberculous mycobacteria (PNTM) disease. DESIGN A retrospective review of 106 patients who were treated at the NIH Clinical Center and met American Thoracic Society/Infectious Diseases Society of America criteria for PNTM. Eligible patients were aged ⩾18 years and did not have cystic fibrosis or human immunodeficiency virus (HIV) infection. RESULTS Of 106 patients followed for a median of 4.9 years, 27 (25%) died during follow-up, for a mortality rate of 4.2 per 100 person-years. The population was predominantly female (88%) and White (88%), with infrequent comorbidities. Fibrocavitary disease (adjusted hazard ratio [aHR] 3.3, 95% confidence interval [CI] 1.3-8.3) and pulmonary hypertension (aHR 2.1, 95%CI 0.9-5.1) were associated with a significantly elevated risk of mortality in survival analysis. CONCLUSIONS PNTM remains a serious public health concern, with a consistently elevated mortality rate across multiple populations. Significant risk factors for death include fibrocavitary disease and pulmonary hypertension. Further research is needed to more specifically identify clinical and microbiologic factors that jointly influence disease outcome.
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Affiliation(s)
- M Fleshner
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - K N Olivier
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - P A Shaw
- Biostatistics Research Branch, Division of Clinical Research, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - J Adjemian
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - S Strollo
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - R J Claypool
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - L Folio
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, USA
| | - A Zelazny
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - D R Prevots
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
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Blanc P, Dutronc H, Peuchant O, Dauchy FA, Cazanave C, Neau D, Wirth G, Pellegrin JL, Morlat P, Mercié P, Tunon-de-Lara JM, Doutre MS, Pélissier P, Dupon M. Nontuberculous Mycobacterial Infections in a French Hospital: A 12-Year Retrospective Study. PLoS One 2016; 11:e0168290. [PMID: 27959960 PMCID: PMC5154556 DOI: 10.1371/journal.pone.0168290] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/29/2016] [Indexed: 01/08/2023] Open
Abstract
Background Nontuberculous mycobacteria (NTM) are environmental organisms associated with a range of infections. Reports of NTM epidemiology are mainly focused on pulmonary infections and isolations, and extrapulmonary infections are less frequently described. Methods We conducted a retrospective study of NTM infections at the Bordeaux University Hospital, France, between January 2002 and December 2013. We used the microbiologic component of the American Thoracic Society/Infectious Diseases Society of America's pulmonary NTM disease criteria to define cases of pulmonary NTM, and patients with isolates from a normally sterile site were classified as having extrapulmonary disease. Results In our setting, 170 patients were included. Pulmonary cases predominated (54.1%), followed by skin and soft tissue infections (22.9%), disseminated cases (10.6%), lymphadenitis (7.7%), bone and joint infections (2.9%) and the remaining 1.8% catheter-related infections. Overall, 16 NTM species were isolated. Mycobacterium avium (31.8%) and M. intracellulare (20%) were the most common species identified, followed by M. marinum (13.5%), M. kansasii (10.6%), M. xenopi (9.4%), rapidly growing mycobacteria (9.4%) and other slowly growing mycobacteria (5.3%). In general, NTM isolates were largely prevalent in people older than 50 (62.4%); patients aged 1–10 year-old exclusively yielded M. avium from lymph nodes, almost cases having being diagnosed after 2007. Among the 121 patients with complete follow-up, 78 (64.5%), 24 (19.8%), and 19 (15.7%) were cured, experienced relapse, or died, respectively. Conclusion In our study, extrapulmonary NTM infections represented almost half of cases, consisting mainly in skin and soft tissue infections. The increase lymphadenitis cases in children after 2007 could be linked to the cessation of mandatory BCG vaccination in France. We observed similar cure rates (64%) between pulmonary and extrapulmonary infections.
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Affiliation(s)
- Peggy Blanc
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hervé Dutronc
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivia Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France
- INRA, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France
- * E-mail:
| | - Frédéric-Antoine Dauchy
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Didier Neau
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gaëtane Wirth
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean-Luc Pellegrin
- Service de médecine interne, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Philippe Morlat
- Service de médecine interne, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Patrick Mercié
- Service de médecine interne, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Marie-Sylvie Doutre
- Service de dermatologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Philippe Pélissier
- Service de chirurgie plastique, reconstructrice et esthétique -brulés- chirurgie de la main, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Michel Dupon
- Service de maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease. Antimicrob Agents Chemother 2016; 60:6758-6765. [PMID: 27572413 DOI: 10.1128/aac.01240-16] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/26/2016] [Indexed: 01/10/2023] Open
Abstract
Macrolide antibiotics are key components of the multidrug treatment regimen for treating lung disease (LD) due to Mycobacterium avium complex (MAC). Despite the emergence of macrolide resistance, limited data are available on macrolide-resistant MAC-LD. This study evaluated the clinical features and treatment outcomes of patients with macrolide-resistant MAC-LD and the molecular characteristics of the macrolide-resistant isolates. A retrospective review of the medical records of 34 patients with macrolide-resistant MAC-LD who were diagnosed between January 2002 and December 2014 was performed, along with genetic analysis of 28 clinical isolates. Nineteen (56%) patients had the fibrocavitary form of MAC-LD, and 15 (44%) had the nodular bronchiectatic form. M. intracellulare was the etiologic organism in 21 (62%) patients. Approximately two-thirds (22/34 [65%]) of the patients had been treated with currently recommended multidrug regimens that included macrolide, ethambutol, and rifamycin prior to the emergence of macrolide resistance, and none had been treated with macrolide monotherapy. The median duration of treatment after the detection of macrolide resistance was 23.0 months (interquartile range, 16.8 to 45.3 months). Treatment outcomes were poor after the development of macrolide resistance, with favorable treatment outcomes achieved in only five (15%) patients, including two patients who underwent surgical resection. One-, 3-, and 5-year mortality rates were 9, 24, and 47%, respectively. Molecular analysis of 28 clinical isolates revealed that 96% (27/28) had point mutations at position 2058 or 2059 of the 23S rRNA gene. Our analyses indicate that more effective therapy is needed to treat macrolide-resistant MAC-LD and prevent its development.
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Salzer HJF, Wassilew N, Köhler N, Olaru ID, Günther G, Herzmann C, Kalsdorf B, Sanchez-Carballo P, Terhalle E, Rolling T, Lange C, Heyckendorf J. Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis. Respiration 2016; 92:199-214. [PMID: 27595540 DOI: 10.1159/000449037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic respiratory infectious diseases are causing high rates of morbidity and mortality worldwide. Tuberculosis, a major cause of chronic pulmonary infection, is currently responsible for approximately 1.5 million deaths per year. Although important advances in the fight against tuberculosis have been made, the progress towards eradication of this disease is being challenged by the dramatic increase in multidrug-resistant bacilli. Nontuberculous mycobacteria causing pulmonary disease and chronic pulmonary aspergillosis are emerging infectious diseases. In contrast to other infectious diseases, chronic respiratory infections share the trait of having highly variable treatment outcomes despite longstanding antimicrobial therapy. Recent scientific progress indicates that medicine is presently at a transition stage from programmatic to personalized management. We explain current state-of-the-art management concepts of chronic pulmonary infectious diseases as well as the underlying methods for therapeutic decisions and their implications for personalized medicine. Furthermore, we describe promising biomarkers and techniques with the potential to serve future individual treatment concepts in this field of difficult-to-treat patients. These include candidate markers to improve individual risk assessment for disease development, the design of tailor-made drug therapy regimens, and individualized biomarker-guided therapy duration to achieve relapse-free cure. In addition, the use of therapeutic drug monitoring to reach optimal drug dosing with the smallest rate of adverse events as well as candidate agents for future host-directed therapies are described. Taken together, personalized medicine will provide opportunities to substantially improve the management and treatment outcome of difficult-to-treat patients with chronic respiratory infections.
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Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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Wassilew N, Hoffmann H, Andrejak C, Lange C. Pulmonary Disease Caused by Non-Tuberculous Mycobacteria. Respiration 2016; 91:386-402. [PMID: 27207809 DOI: 10.1159/000445906] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.
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Affiliation(s)
- Nasstasja Wassilew
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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Kwon YS, Koh WJ. Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease. J Korean Med Sci 2016; 31:649-59. [PMID: 27134484 PMCID: PMC4835588 DOI: 10.3346/jkms.2016.31.5.649] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/01/2016] [Indexed: 01/15/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) are ubiquitous organisms; their isolation from clinical specimens does not always indicate clinical disease. The incidence of NTM lung diseases has been increasing worldwide. Although the geographic diversity of NTM species is well known, Mycobacterium avium complex (MAC), M. abscessus complex (MABC), and M. kansasii are the most commonly encountered and important etiologic organisms. Two distinct types of NTM lung diseases have been reported, namely fibrocavitary and nodular bronchiectatic forms. For laboratory diagnosis of NTM lung diseases, both liquid and solid media cultures and species-level identification are strongly recommended to enhance growth detection and determine the clinical relevance of isolates. Treatment for NTM lung diseases consists of a multidrug regimen and a long course of therapy, lasting more than 12 months after negative sputum conversion. For MAC lung disease, several new macrolide-based regimens are now recommended. For nodular bronchiectatic forms of MAC lung diseases, an intermittent three-time-weekly regimen produces outcomes similar to those of daily therapy. Treatment of MABC lung disease is very difficult, requiring long-term use of parenteral agents in combination with new macrolides. Treatment outcomes are much better for M. massiliense lung disease than for M. abscessus lung disease. Thus, precise identification of species in MABC infection is needed for the prediction of antibiotic response. Likewise, increased efforts to improve treatment outcomes and develop new agents for NTM lung disease are needed.
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Affiliation(s)
- Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ryu YJ, Koh WJ, Daley CL. Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians' Perspectives. Tuberc Respir Dis (Seoul) 2016; 79:74-84. [PMID: 27066084 PMCID: PMC4823187 DOI: 10.4046/trd.2016.79.2.74] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/10/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) are emerging pathogens that affect both immunocompromised and immunocompetent patients. The incidence and prevalence of NTM lung disease are increasing worldwide and rapidly becoming a major public health problem. For the diagnosis of NTM lung disease, patients suspected to have NTM lung disease are required to meet all clinical and microbiologic criteria. The development of molecular methods allows the characterization of new species and NTM identification at a subspecies level. Even after the identification of NTM species from respiratory specimens, clinicians should consider the clinical significance of such findings. Besides the limited options, treatment is lengthy and varies by species, and therefore a challenge. Treatment may be complicated by potential toxicity with discouraging outcomes. The decision to start treatment for NTM lung disease is not easy and requires careful individualized analysis of risks and benefits. Clinicians should be alert to those unique aspects of NTM lung disease concerning diagnosis with advanced molecular methods and treatment with limited options. Current recommendations and recent advances for diagnosis and treatment of NTM lung disease are summarized in this article.
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Affiliation(s)
- Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
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Stout JE, Koh WJ, Yew WW. Update on pulmonary disease due to non-tuberculous mycobacteria. Int J Infect Dis 2016; 45:123-34. [PMID: 26976549 DOI: 10.1016/j.ijid.2016.03.006] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 01/01/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are emerging worldwide as significant causes of chronic pulmonary infection, posing a number of challenges for both clinicians and researchers. While a number of studies worldwide have described an increasing prevalence of NTM pulmonary disease over time, population-based data are relatively sparse and subject to ascertainment bias. Furthermore, the disease is geographically heterogeneous. While some species are commonly implicated worldwide (Mycobacterium avium complex, Mycobacterium abscessus), others (e.g., Mycobacterium malmoense, Mycobacterium xenopi) are regionally important. Thoracic computed tomography, microbiological testing with identification to the species level, and local epidemiology must all be taken into account to accurately diagnose NTM pulmonary disease. A diagnosis of NTM pulmonary disease does not necessarily imply that treatment is required; a patient-centered approach is essential. When treatment is required, multidrug therapy based on appropriate susceptibility testing for the species in question should be used. New diagnostic and therapeutic modalities are needed to optimize the management of these complicated infections.
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Affiliation(s)
- Jason E Stout
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359-DUMC, Durham, NC 27710, USA.
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wing Wai Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
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Novosad S, Henkle E, Winthrop KL. The Challenge of Pulmonary Nontuberculous Mycobacterial Infection. CURRENT PULMONOLOGY REPORTS 2015; 4:152-161. [PMID: 26877911 DOI: 10.1007/s13665-015-0119-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The incidence of nontuberculous mycobacterial (NTM) lung disease is increasing. Current treatment strategies are largely based on expert opinion. The lack of randomized clinical trials to inform treatment leave clinicians with many questions regarding the most effective and safe regimens. The risk-benefit ratio of therapy is often thought to favor observation given the chronic nature of the disease, multiple long-term antibiotics recommended for therapy, side effects associated with treatment, and perceived lack of efficacious therapies.
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Affiliation(s)
- Shannon Novosad
- Pulmonary & Critical Care Medicine Oregon Health & Science University 3181 SW Sam Jackson Park Road, UHN 67 Portland, OR, 97239 USA
| | - Emily Henkle
- School of medicine Public Health & Preventive Medicine Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR, 97239 USA
| | - Kevin L Winthrop
- Department of Medicine Division of Infectious Diseases Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland, OR, 97239 USA
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