Treatment of Mycobacterium abscessus pulmonary disease (MAB-PD), caused by M. abscessus subsp. abscessus, M. abscessus subsp. massiliense or M. abscessus subsp. bolletii, is challenging.We conducted an individual patient data meta-analysis based on studies reporting treatment outcomes for MAB-PD to clarify treatment outcomes for MAB-PD and the impact of each drug on treatment outcomes. Treatment success was defined as culture conversion for ≥12 months while on treatment or sustained culture conversion without relapse until the end of treatment.Among 14 eligible studies, datasets from eight studies were provided and a total of 303 patients with MAB-PD were included in the analysis. The treatment success rate across all patients with MAB-PD was 45.6%. The specific treatment success rates were 33.0% for M. abscessus subsp. abscessus and 56.7% for M. abscessus subsp. massiliense. For MAB-PD overall, the use of imipenem was associated with treatment success (adjusted odds ratio (aOR) 2.65, 95% CI 1.36–5.10). For patients with M. abscessus subsp. abscessus, the use of azithromycin (aOR 3.29, 95% CI 1.26–8.62), parenteral amikacin (aOR 1.44, 95% CI 1.05–1.99) or imipenem (aOR 7.96, 95% CI 1.52–41.6) was related to treatment success. For patients with M. abscessus subsp. massiliense, the choice among these drugs was not associated with treatment outcomes.Treatment outcomes for MAB-PD are unsatisfactory. The use of azithromycin, amikacin or imipenem was associated with better outcomes for patients with M. abscessus subsp. abscessus.
Isolation frequency of nontuberculous mycobacterial (NTM) differs per region. Differences in isolation frequency as well as frequencies in clinical relevance are relevant for daily clinical practice. We conducted a systematic review, searching PubMed to assess these differences. complex (MAC) is the most frequently isolated species and the majority of MAC isolates are causative agents of clinically relevant disease, that is, the patient ultimately meets American Thoracic Society/Infectious Disease Society of America diagnostic criteria for NTM pulmonary disease. Differences in isolation frequency between MAC species are seen in different continents. Another species that shows a remarkable difference in isolation frequency is complex, which is common in Asia and Oceania, in contrast to Europe, North America, and South America. Furthermore, differences in isolation frequency are seen between different continents, and also between regions or cities. These differences might drive local epidemiology of NTM pulmonary disease, and knowledge of the local situation is thus essential for daily clinical practice. To be fully able to assess this problem, larger multicenter studies with uniform microbiological methods are needed.
Fibro-cavitary NTM-PD remains predominant, but is now diagnosed more frequently in women. Fibro-cavitary disease is harder to cure than nodular-bronchiectatic disease. Adverse events are frequent and can necessitate cessation of treatment.
To the Editor: 5 years ago, a then 50-year-old woman presented with long-standing fatigue, dyspnoea and a chronic productive cough. Based on a computed tomography scan of the thorax and multiple positive cultures, she was diagnosed with nodular-bronchiectatic Mycobacterium avium pulmonary disease; she was also found to have a heterozygous F508del CFTR gene mutation. She commenced therapy with rifabutin 300 mg once daily, ethambutol 1200 mg once daily and azithromycin 500 mg once daily. After 15 months of ongoing symptoms, radiographic deterioration and persistent culture positivity, clofazimine 100 mg once daily and thrice weekly intravenous amikacin 15 mg•kg −1 were added to the regimen. Amikacin was halted after 4 months; the remaining four drugs were continued. The dose of azithromycin was lowered to 250 mg once daily after 9 months because of hearing loss.
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