Antibiotic therapy success rate in pulmonary Mycobacterium avium complex: a systematic review and meta-analysis

Nasiri, Mohammad Javad; Ebrahimi, Golnaz; Arefzadeh, Samaneh; Zamani, Samin; Nikpor, Zahra; Mirsaeidi, Mehdi

doi:10.1080/14787210.2020.1720650

Cited by 21 publications

(14 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 Patients who meet these diagnostic criteria, particularly patients with smear positivity or fibrocavitary disease, should be treated because of risk of un-favorable outcomes. 15,[20][21][22] However, we found that the initiation of guidelinerecommended antimycobacterial therapy in veterans without HIV with MAC-PD were inconsistent among HCPs. The reasons underlying this phenomenon were not apparent beyond cited reasons for treatment initiation or deference.…”

Section: Discussionmentioning

confidence: 82%

Preliminary Observations of Veterans Without HIV Who Have Mycobacterium avium Complex Pulmonary Disease

Vagts¹

2022

Federal Practitioner

View full text Add to dashboard Cite

MARCH 2022 • FEDERAL PRACTITIONER • 125 mdedge.com/fedprac Background:Nontuberculous Mycobacterium-related pulmonary disease (NTM-PD) is commonly caused by Mycobacterium avium complex (MAC) and is increasingly recognized in veterans. NTM-PD carries an increased risk of mortality, and lack of treatment is an predictor of increased mortality. Methods: We describe the clinical characteristics of veterans diagnosed with MAC-pulmonary disease (MAC-PD) followed in a health care setting with varying treatment practices. We reviewed the electronic health records of veterans without HIV who had sputum culture-positive MAC-PD followed at the Jesse Brown Veteran Affairs Medical Center in Chicago, Illinois. Results: We identified 19 veterans diagnosed with MAC-PD between 2008 and 2019. They were predominantly male (89.5%), Black (73.6%), and had a median age of 74 years. Sixteen veterans (84.2%) had underlying lung disease, and 16 (84.2%) were current or former smokers. Respiratory symptoms were reported in 17 veterans (89.5%). Guideline-directed combination antimycobacterial therapy was initiated in 10 veterans (52.6%); however, only 5 (50.0%) completed treatment. Comorbidities, symptoms, and findings on chest imaging at diagnosis were similar among treated and untreated veterans. Conclusions: Clinical, imaging, and treatment attributes of MAC-PD in veterans without HIV who reside in metropolitan Chicago are heterogeneous and are associated with a relatively high mortality rate. Further studies are warranted to characterize MAC-PD and its treatment in veterans without HIV who reside in underresourced urban communities in the US.

show abstract

Section: Discussionmentioning

confidence: 82%

Preliminary Observations of Veterans Without HIV Who Have Mycobacterium avium Complex Pulmonary Disease

Vagts¹

2022

Federal Practitioner

View full text Add to dashboard Cite

show abstract

“…Other studies show that treatment success for MAC pulmonary disease is lower in patients with fibrocavitary disease than in those with nodular-bronchiectatic MAC pulmonary disease [18]; treatment success in this latter group exceeds 80% [18,69], with macrolide-containing regimens in macrolide-sensitive organisms more likely to succeed [70,71]. The 5-year all-cause mortality rate also varies between 5% and 42% across MAC studies, with death more likely in those with fibrocavitary disease compared with nodular-bronchiectatic disease [6].…”

Section: Treatment Challenges Of Ntm Pulmonary Diseasementioning

confidence: 99%

Liposomal drug delivery to manage nontuberculous mycobacterial pulmonary disease and other chronic lung infections

Chalmers

Ingen

Laan³

et al. 2021

Eur Respir Rev

View full text Add to dashboard Cite

Nontuberculous mycobacterial (NTM) pulmonary disease is a chronic respiratory infection associated with declining lung function, radiological deterioration and significantly increased morbidity and mortality. Patients often have underlying lung conditions, particularly bronchiectasis and COPD. NTM pulmonary disease is difficult to treat because mycobacteria can evade host defences and antimicrobial therapy through extracellular persistence in biofilms and sequestration into macrophages. Management of NTM pulmonary disease remains challenging and outcomes are often poor, partly due to limited penetration of antibiotics into intracellular spaces and biofilms. Efficient drug delivery to the site of infection is therefore a key objective of treatment, but there is high variability in lung penetration by antibiotics. Inhalation is the most direct route of delivery and has demonstrated increased efficacy of antibiotics like amikacin compared with systemic administration. Liposomes are small, artificial, enclosed spherical vesicles, in which drug molecules can be encapsulated to provide controlled release, with potentially improved pharmacokinetics and reduced toxicity. They are especially useful for drugs where penetration of cell membranes is essential. Inhaled delivery of liposomal drug solutions can therefore facilitate direct access to macrophages in the lung where the infecting NTM may reside. A range of liposomal drugs are currently being evaluated in respiratory diseases.

show abstract

“…Recent meta-analyses of antibiotic therapy in NTM-PDs have shown that aminoglycoside- and macrolide-containing regimens have success rates <70%. 6 , 7 In addition, the treatment is complicated and intensive due to natural and acquired antibiotic resistance. 1 , 8 , 9 Moreover, recent studies have suggested the possible direct transmission of emergent NTM within the population, 10 , 11 necessitating the development of new protective and therapeutic modalities against emerging NTM-PDs.…”

Section: Introductionmentioning

confidence: 99%

Arginine-mediated gut microbiome remodeling promotes host pulmonary immune defense against nontuberculous mycobacterial infection

Kim

Lee

et al. 2022

Gut Microbes

View full text Add to dashboard Cite

Nontuberculous mycobacterial pulmonary diseases (NTM-PDs) are emerging as global health threats with issues of antibiotic resistance. Accumulating evidence suggests that the gut–lung axis may provide novel candidates for host-directed therapeutics against various infectious diseases. However, little is known about the gut–lung axis in the context of host protective immunity to identify new therapeutics for NTM-PDs. This study was performed to identify gut microbes and metabolites capable of conferring pulmonary immunity to NTM-PDs. Using metabolomics analysis of sera from NTM-PD patients and mouse models, we showed that the levels of l -arginine were decreased in sera from NTM-PD patients and NTM-infected mice. Oral administration of l -arginine significantly enhanced pulmonary antimicrobial activities with the expansion of IFN-γ-producing effector T cells and a shift to microbicidal (M1) macrophages in the lungs of NTM-PD model mice. Mice that received fecal microbiota transplants from l -arginine-treated mice showed increased protective host defense in the lungs against NTM-PD, whereas l -arginine-induced pulmonary host defense was attenuated in mice treated with antibiotics. Using 16S rRNA sequencing, we further showed that l -arginine administration resulted in enrichment of the gut microbiota composition with Bifidobacterium species. Notably, oral treatment with either Bifidobacterium pseudolongum or inosine enhanced antimicrobial pulmonary immune defense against NTM infection, even with multidrug-resistant clinical NTM strains. Our findings indicate that l -arginine-induced gut microbiota remodeling with enrichment of B. pseudolongum boosts pulmonary immune defense against NTM infection by driving the protective gut–lung axis in vivo .

show abstract

Antibiotic therapy success rate in pulmonary Mycobacterium avium complex: a systematic review and meta-analysis

Cited by 21 publications

References 64 publications

Preliminary Observations of Veterans Without HIV Who Have Mycobacterium avium Complex Pulmonary Disease

Preliminary Observations of Veterans Without HIV Who Have Mycobacterium avium Complex Pulmonary Disease

Liposomal drug delivery to manage nontuberculous mycobacterial pulmonary disease and other chronic lung infections

Arginine-mediated gut microbiome remodeling promotes host pulmonary immune defense against nontuberculous mycobacterial infection

Contact Info

Product

Resources

About