Risk factors for nontuberculous mycobacterial infections in solid organ transplant recipients: a case–control study

Longworth, Sarah; Vinnard, Christopher; Lee, I.; Sims, Karen; Barton, Todd D.; Blumberg, Emily A.

doi:10.1111/tid.12170

Cited by 80 publications

(65 citation statements)

References 13 publications

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“…Redelman-Sidi et al reported 44 cases of M. abscessus complex over a 10-year period at a large cancer center in New York [22]; Candido et al reported 30/129 patients with cystic fibrosis with NTM pulmonary infections over a 4-year period in Brazil [23]. Longworth et al recently reported 15 cases of M. abscessus out of 34 (44%) NTB infections in solid organ transplant recipients over a 7.5-year period [24], and Knoll et al reported 5/53 (9.4%) cases of M. abscessus complex in 53 transplant recipient patients who had 1 or more cultures positive for NTM over 15 years [25]. Smaller cases series of M. abscessus complex have been reported by others [26–28].…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Sfeir

Walsh

Rosa

et al. 2018

Open Forum Infectious Diseases

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BackgroundInfections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States.MethodsA retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement.ResultsOne hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53–81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4–31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7–23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6–21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9–21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2–3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57–18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002–1.8; P = .04).ConclusionsOur cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

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Section: Discussionmentioning

confidence: 99%

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Sfeir

Walsh

Rosa

et al. 2018

Open Forum Infectious Diseases

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“…When present, they most commonly manifest as pulmonary and multifocal cutaneous infections. 57 Treatment of tuberculosis in this population has its own concerns. Rifampicin is a strong enzyme inducer and may increase metabolism of cytochrome P-450 significantly.…”

Section: Correct Answers: a And Cmentioning

confidence: 99%

Hepatobiliary Quiz (Answers)—13 (2015)

Rathi

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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“…Mycobacterium abscessus and Mycobacterium avium complex were the most common pathogens, and the lung (including pleura) was the most common site of disease. In this adjusted case-control analysis, lung transplant recipients had the highest risk of NTM disease [52]. According to Knoll et al, NTM were isolated from 53 of 237 patients (22.4%) following lung transplantation over a median of 25.2 months follow-up.…”

Section: Ntm and Organ Transplantationmentioning

confidence: 99%

Highlight on Advances in Nontuberculous Mycobacterial Disease in North America

Mirsaeidi

Farshidpour

Allen

et al. 2014

BioMed Research International

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Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and exist as an important cause of pulmonary infections in humans. Pulmonary involvement is the most common disease manifestation of NTM and the incidence of NTM is growing in North America. Susceptibility to NTM infection is incompletely understood; therefore preventative tools are not well defined. Treatment of pulmonary nontuberculous mycobacterial (NTM) infection is difficult and entails multiple antibiotics and an extended treatment course. Also, there is a considerable variation in treatment management that should be considered before initiating treatment. We highlight the new findings in the epidemiology diagnosis and treatment of mycobacterial infections. We debate new advances regarding NTM infection in cystic fibrosis patients and solid organ transplant recipients. Finally, we introduce a new epidemiologic model for NTM disease based on virulence-exposure-host factors.

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Risk factors for nontuberculous mycobacterial infections in solid organ transplant recipients: a case–control study

Abstract: Additional studies are needed to evaluate the role of targeted surveillance measures for NTM disease in high-risk patients, particularly lung transplant recipients, and to characterize the mechanisms of disease acquisition.

Cited by 80 publications

References 13 publications

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

Hepatobiliary Quiz (Answers)—13 (2015)

Highlight on Advances in Nontuberculous Mycobacterial Disease in North America

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