Nationwide evaluation of treatment outcomes and survival of patients with non-tuberculous mycobacterial pulmonary disease

BACKGROUND Treatment outcomes and long-term survival of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in a real-world setting are difficult to assess, especially for species other than Mycobacterium avium complex (MAC). METHODS This was a retrospective cohort study on all Croatian residen...

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Published in:	The international journal of tuberculosis and lung disease Vol. 28; no. 10; pp. 482 - 487
Main Authors:	Makek, M.J., Glodic, G., Sabol, I., Zmak, L., Samarzija, M., Sola, A., Marusic, A., Marekovic, I., Bulat, L.K., Corak, L., Obrovac, M., van Ingen, J.
Format:	Journal Article
Language:	English
Published:	France International Union Against Tuberculosis and Lung Disease 01-10-2024 International Union against Tuberculosis and Lung Disease (IUATLD)
Subjects:	Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Clinical outcomes Croatia Female Humans Long-Term Survival Lung diseases Lung Diseases - microbiology Lung Diseases - mortality Lung Diseases - therapy Male Middle Aged Mycobacterium Infections, Nontuberculous - drug therapy Mycobacterium Infections, Nontuberculous - microbiology Mycobacterium Infections, Nontuberculous - mortality Nontuberculous Mycobacteria - isolation & purification Ntm-Pd Retrospective Studies Sputum Sputum - microbiology Survival Treatment Outcome Treatment Outcomes Tuberculosis Croatia
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Summary:	BACKGROUND Treatment outcomes and long-term survival of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in a real-world setting are difficult to assess, especially for species other than Mycobacterium avium complex (MAC). METHODS This was a retrospective cohort study on all Croatian residents with respiratory NTM isolates from 2006 to 2015, with follow-up to 2020. RESULTS Therapy was started in 98/137 (71.5%) of patients, significantly more often in patients with fibrocavitary disease and/or sputum smear positivity. Unsuccessful treatment outcomes were recorded in 39/98 (39.8%) patients (14 deaths and 25 treatment failures). One-year and 5-year all-cause mortality were respectively 18.2% and 37.6%. Guideline-based treatment (GBT) was started in 50/98 (51%) of treated patients and followed for the recommended duration in 35.7% (35/98). This resulted in a higher chance of cure (OR 3.79, 95% CI 1.29 to 11.1; P = 0.012) than inadequately treated/untreated patients. For Mycobacterium xenopi disease, high cure rates (>80%) were achieved both with GBT and non-GBT treatment regimens. CONCLUSION Guideline-based therapy resulted in a four-time higher chance of being cured. The impact of GBT on treatment outcomes was clear for MAC disease, but no apparent effect was observed for patients with M. xenopi disease.
Bibliography:	(R) Medicine - General 1027-3719(20241001)28:10L.482;1- ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1027-3719 1815-7920 1815-7920
DOI:	10.5588/ijtld.24.0068