Impacts of Nontuberculous Mycobacteria Isolates in Non-cystic Fibrosis Bronchiectasis: A 16-Year Cohort Study in Taiwan

Abstract

BackgroundThe prevalence of nontuberculous mycobacteria (NTM) in patients with chronic respiratory disease has increased. The implication of NTM in non-CF bronchiectasis remained controversial. This study investigated the impact of NTM in non-CF bronchiectasis in Taiwan.MethodsClinical manifestation, imaging, and microbiological data were retrieved from the Chang Gung Research Database, the largest electronic medical record-based database in Taiwan. Patients with bronchiectasis during 2001–2016 were included. Cox proportional hazard model was employed to compare outcomes between patients with negative and positive NTM isolates after 1:1 propensity score matching.ResultsA total of 19,647 non-CF bronchiectasis patients were enrolled and 11,492 patients were eligible for analysis after exclusion screening. Finally, patients with negative and positive NTM isolates—650 each—were analyzed after propensity score matching. The patients with negative NTM isolates were divided into three groups: Pseudomonas aeruginosa isolates (n = 53); fungus isolates (n = 26); and concomitant P. aeruginosa and fungus isolates (n = 8). The patients with positive NTM isolates were divided into five groups: single NTM isolate (n = 458); multiple NTM isolates (n = 60); concomitant NTM and P. aeruginosa isolates (n = 89); concomitant NTM and fungus isolates (n = 33); and concomitant NTM, P. aeruginosa, and fungus isolates (n = 10). Patients with P. aeruginosa isolates; concomitant NTM and P. aeruginosa isolates; concomitant NTM, P. aeruginosa, and fungus isolates had independently associated with respiratory failure and death. Patients with single or multiple NTM isolates were not related to ventilator use, but both were independent risk factor for mortality.ConclusionNTM, either combined with P. aeruginosa or fungus, exhibited more frequent exacerbations in non-CF bronchiectasis patients. Moreover, NTM predicted mortality in non-CF bronchiectasis patients and were also correlated to respiratory failure while concomitantly isolated with P. aeruginosa and fungus.

Clinical outcomes and prognostic factors of bronchiectasis rheumatoid overlap syndrome: A multi-institution cohort study

“…For the patients with BROS who used bDMARDs, the risks of NTM and tuberculosis were increased. NTM infection is associated with higher rates of respiratory failure and mortality and sometimes with P. aeruginosa or fungal coinfection, causing more frequent exacerbations in patients with bronchiectasis ( 33 , 34 ). The use of bDMARDs should be cautious in patients with BROS to avoid aggravating the vicious cycle of bronchiectasis.…”

Non-tuberculous mycobacterial pulmonary disease (NTM-PD): Epidemiology, diagnosis and multidisciplinary management

“…Respiratory physiotherapy is an integral part of the daily management of NTM-PD. Persistent detection of NTM in sputum is associated with worse outcomes 29 and physiotherapy interventions have been shown to mitigate this in people with bronchiectasis and CF. 30 , 31 The aims of physiotherapy are to maintain ventilation in all parts of the lungs; postpone progression of pulmonary disease; stimulate establishment and retention of normal physical capacity; and avoid pain and musculoskeletal complications due to pulmonary or bone disease.…”

Inhaled Antibiotics in Non-cystic Fibrosis Bronchiectasis (NCFB): A Systematic Review of Efficacy and Limitations in Adult Patients

“…Non-tuberculous mycobacterium, viral and fungal infections are also less frequently responsible for exacerbations. Irreversible structural remodeling of the airways leads to a vicious cycle of infections which further propels the person toward progressive loss of lung function [6]. Acute and preventive management of infections is therefore pertinent to reducing bronchial inflammation, improving quality of life, and achieving long-term positive outcomes [7,8].…”