M8 Non-tuberculous mycobacteria testing in bronchiectasis in the UK: data from the EMBARC registry

Finch, Simon; Laan, Roald van der; Crichton, Megan; Clifton, Ian; Gatheral, Timothy; Walker, Paul; Haworth, Charles; Hill, AT; Loebinger, Michael R.; Goeminne, PC; Aliberti, Stefano; Polverino, Eva; Soyza, Anthony De; Chalmers, JD

doi:10.1136/thorax-2019-btsabstracts2019.416

Cited by 5 publications

(7 citation statements)

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“…Findings from previous surveys also report low levels of testing in patients with bronchiectasis prior to initiating long-term macrolide therapy [21,34]. Macrolides are the backbone of NTM-PD therapy and macrolide monotherapy in the presence of NTM infection is a risk factor for macrolide resistance [25,36]; therefore, testing patients for NTM when considering use of macrolides should be undertaken, in line with guidelines, to retain possible future treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…[ 21 ], who demonstrated in a European survey that 85% of physicians tested at least some of their patients with bronchiectasis. Data from the EMBARC registry also highlighted wide regional variation in testing frequency in the UK, ranging from 8.3% to 35.5% of patients with bronchiectasis [ 34 ]. In the current survey, 60% of physicians considered testing patients with CF and only 50% of these tested all adults with CF despite guideline recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…Results are similar to a survey of testing practice in patients with bronchiectasis in the Asia-Pacific region that noted that 21% of physicians performed acid-fast bacilli smear tests and cultures at the initial visit [ 35 ]. Findings from previous surveys also report low levels of testing in patients with bronchiectasis prior to initiating long-term macrolide therapy [ 21 , 34 ]. Macrolides are the backbone of NTM-PD therapy and macrolide monotherapy in the presence of NTM infection is a risk factor for macrolide resistance [ 25 , 36 ]; therefore, testing patients for NTM when considering use of macrolides should be undertaken, in line with guidelines, to retain possible future treatment options.…”

Section: Discussionmentioning

confidence: 99%

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Global survey of physician testing practices for nontuberculous mycobacteria

Loebinger

Laan²,

Obradović³

et al. 2023

ERJ Open Res

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BackgroundCertain patients are at greater risk of developing non-tuberculous mycobacterial pulmonary disease (NTM-PD), including those with lung conditions such as bronchiectasis. Testing for non-tuberculous mycobacteria (NTM) in patients at risk is necessary to identify NTM-PD and start appropriate management. The aim of this survey was to evaluate current testing practices for NTM and identify testing triggers.MethodsPhysicians (n=455) who see ≥1 patient with NTM-PD in a typical 12-month period and test for NTM as part of practice from Europe, the USA, Canada, Australia, New Zealand and Japan participated in a 10-min anonymised survey on NTM testing practices.ResultsBronchiectasis, chronic obstructive pulmonary disease (COPD) and use of immunosuppressants were the factors most likely to prompt testing among physicians in this survey (90%, 64% and 64%, respectively) with radiological findings the most common reason leading to considering NTM testing in patients with bronchiectasis and COPD (62% and 74%, respectively). Macrolide monotherapy in patients with bronchiectasis and inhaled corticosteroid use in patients with COPD were not important triggers for testing (15% and 9% of physicians, respectively). Persistent cough and weight loss triggered testing in >75% of physicians. Testing triggers were markedly different for physicians in Japan, with CF prompting testing in fewer physicians compared with other regions.ConclusionsTesting for NTM is influenced by underlying disease, clinical symptoms or radiological changes, but clinical practice varies considerably. Adherence to guideline recommendations for NTM testing is limited in certain patient subgroups and varies across regions. Clear recommendations on NTM testing are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Global survey of physician testing practices for nontuberculous mycobacteria

Loebinger

Laan²,

Obradović³

et al. 2023

ERJ Open Res

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“…This can cause considerable delays in diagnosis:the median time from symptom onset to diagnosis has been estimated to be at least two years (Ahmed et al, 2020). Current guidelines recommend tests for NTM infection in patients with bronchiectasis (Haworth et al, 2017), but this is performed in less than a fifth of patients (Finch et al, 2019). Thus, many are failed by services that miss detecting NTM earlier in its natural history and so allow progression to chronic symptoms and lung damage often associated with prolonged NTM-PD.…”

Section: Making a Diagnosis And Planning Medical Treatmentmentioning

confidence: 99%

Non tuberculous mycobacteria pulmonary disease: patients and clinicians working together to improve the evidence base for care

Lipman

Kunst

Loebinger

et al. 2021

International Journal of Infectious Diseases

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Non-tuberculous mycobacterial pulmonary disease is on the rise globally. It is often missed, and causes significant morbidity and even mortality. Here, members of a clinical research network and a patient support group discuss some of the current key issues in NTM management.In addition to the need for research into epidemiology, immunology and treatment, we recommend greater use of patient and clinician networks to: (i) educate primary and secondary care clinicians to develop a high index of suspicion when investigating and treating at risk populations. (ii) promote a multidisciplinary team. (iii) promote shared patient-clinician decision making throughout care. (iv) incorporate use of patient self-report measures to assess progress and outcomes. (v) increase education of patients on their illness and its management. (vi) recruit patients into research projects and registries to improve the clinical evidence base. (vii) increase co-production of research with key stakeholders such as patients and their families, using expert patients and patient groups. (viii) understand more about the psychological, social and economic consequences of the disease.

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“…Airway infections play a central role in the pathogenesis of bronchiectasis [2][3][4]. Of these microorganisms, nontuberculous mycobacteria (NTM) have become a seriously emerging pathogen with estimates ranging from 0.6 to 50% in patients with bronchiectasis [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Nontuberculous Mycobacteria in Patients with Bronchiectasis: A Systematic Review and Meta-Analysis

Zhu

Xie

et al. 2021

Respiration

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Background: Although international bronchiectasis guidelines recommended screening of nontuberculous mycobacteria (NTM) both at initial evaluation and prior to administration of macrolide treatment, data regarding NTM in bronchiectasis remain elusive. Objective: To establish the prevalence, species, and clinical features of NTM in adults with bronchiectasis. Methods: We searched PubMed, Embase, and Web of Science for studies published before April 2020 reporting the prevalence of NTM in adults with bronchiectasis. We only included studies with bronchiectasis confirmed by computed tomography and NTM identified by mycobacteria culture or molecular methods. Random-effects meta-analysis was employed. Results: Of the 2,229 citations identified, 21 studies, including 12,454 bronchiectasis patients were included in the final meta-analysis. The overall pooled prevalence of NTM isolation and pulmonary NTM disease were 7.7% (5.0%–11.7%) (n/N = 2,677/12,454) and 4.1% (1.4%–11.4%) (n/N = 30/559), respectively, with significant heterogeneity (I2 = 97.7%, p < 0.001 and I2 = 79.9%, p = 0.007; respectively). The prevalence of NTM isolation varied significantly among different geographical regions with the highest isolation at 50.0% (47.3%–52.7%) reported in the United States. Mycobacterium avium complex and Mycobacterium abscessus complex accounted for 66 and 16.6% of all species, respectively. Some clinical and radiological differences were noted between patients with and without the presence of NTM isolation although the results are inconsistent. Conclusions: Heterogeneity in prevalence estimates of NTM isolation indicated that both local surveys to inform development of clinical services tailored to patients with bronchiectasis and population-based studies are needed. The clinical features associated with NTM in bronchiectasis and their incremental utility in studying the association is unknown and merits further investigation.

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M8 Non-tuberculous mycobacteria testing in bronchiectasis in the UK: data from the EMBARC registry

Cited by 5 publications

References 0 publications

Global survey of physician testing practices for nontuberculous mycobacteria

Global survey of physician testing practices for nontuberculous mycobacteria

Non tuberculous mycobacteria pulmonary disease: patients and clinicians working together to improve the evidence base for care

Prevalence and Clinical Characteristics of Nontuberculous Mycobacteria in Patients with Bronchiectasis: A Systematic Review and Meta-Analysis

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