Treatment outcomes of Mycobacterium avium complex pulmonary disease according to disease severity

Abstract

Mycobacterium avium complex pulmonary disease (MAC-PD) requires long-term treatment. We analyzed the outcomes of 992 MAC-PD patients according to disease severity and compared the outcomes of intermittent and daily therapy for mild disease. Patients were divided into groups according to severity using the body mass index, age, cavity, erythrocyte sedimentation rate, and sex (BACES) system, and culture conversion rates were evaluated. We also evaluated the effects of intermittent treatment on the culture conversion rates in mild disease group. Using the BACES, 992 patients were divided into mild (n = 331), moderate (n = 503), and severe (n = 158) disease groups, and culture conversion at the end of treatment was achieved in 85% (282/331), 80% (403/503), and 61% (97/158), respectively. Differences in culture conversion among the severity groups were significant (p < 0.001). In patients with mild disease, culture conversion rates were similar between intermittent (84%, 166/198) and daily (87%, 116/133) treatment (p = 0.396), and intermittent antibiotic therapy did not negatively impact culture conversion (adjusted hazard ratio 1.08; confidence interval 0.83–1.41; p = 0.578). MAC-PD patients with mild disease had higher culture conversion rates. Daily and intermittent therapy yielded similar culture conversion rates for mild disease. Treatment strategies with lower pill burden may be applicable in mild MAC-PD.

Treatment outcomes and relapse in patients with Mycobacterium avium-intracellulare complex pulmonary disease

“…Only patients with MAC-PD treated with the M + R + EMB-based regimen showed a higher microbiological cure rate. The culture-negative conversion rate in our study was 31%, which was lower than that in previous studies ( 16 ). This lower conversion rate may be because only 69% of patients received M + R + EMB-based regimens and the relatively short treatment duration of 324 days.…”

“…Treatment durations of <12 months had similar success rates (66%) to treatment durations of ≥12 months (68%) ( 11 ). A South Korean cohort found a 61%–85% sputum culture conversion rate for MAD-PD patients treated with an M + R + EMB-based regimen for ≥12 months ( 16 ). However, the evidence supporting this treatment duration is limited.…”

The Clinical Implications of Serum Carbohydrate Antigen 19-9 Levels in Patients with Nontuberculous Mycobacteria Pulmonary Disease

“…BACES severity was originally developed as an indicator that reflects the survival rates of NTM-PD patients [26]. It is known that BACES severe patients have a higher mortality rate compared to BACES mild patients, and this finding has been consistent not only in South Korea study but also in recent validation studies conducted in Canada [27,28,31]. Furthermore, recent studies have reported that treatment responses vary depending on the severity of BACES, with BACES severe patients showing lower cure rates compared to those with BACES mild [27,28].…”

“…NTM-PD severity was determined using the BACES score [body mass index < 18.5 kg/m 2 , age ≥ 65 years, presence of cavity, elevated erythrocyte sedimentation rate (ESR) in men > 15 mm/h and in women > 20 mm/h, and male sex; each worth one point]. One point was assigned for each item, and the total score was considered an indicator of mild (0-1 point), moderate (2-3 points), or severe (4-5 points) disease [26][27][28].…”

Comparison of the sputum microbiome between patients with stable nontuberculous mycobacterial pulmonary disease and patients requiring treatment

“…However, there are limited data on the role of the microbiome in the course of NTM-PD. [11,12] Therefore, this study compared the bacterial microbiomes in the sputum of NTM-PD patients who remained stable without antibiotics and those who required treatment for disease progression to determine whether there were signi cant differences in the microbiomes of the two groups and, in particular, to evaluate the characteristics of the respiratory microbial environment in NTM-PD patients with stable clinical status. We believe that our ndings will improve our understanding of how the respiratory microbial environment in uences the course of NTM-PD.…”