Microbiological persistence in patients with mycobacterium avium complex lung disease: The predictors and the impact on radiographic progression
Journal
Clinical Infectious Diseases
Journal Volume
65
Journal Issue
6
Pages
927-934
Date Issued
2017
Author(s)
Abstract
Background. Persistent growth of Mycobacterium avium complex (MAC) in the lungs indicates continuous infection in MAC lung disease (MAC-LD), but its clinical significance has not been investigated. We aimed to evaluate the predictors of persistent culture-positivity for MAC (MAC-PP) and its impact on radiographic deterioration in MAC-LD. Methods. Patients with MAC-LD at multiple medical centers from 2011 to 2016 were enrolled retrospectively. Microbiological persistence of MAC-LD was defined as MAC-PP exceeding 1 year, in contrast with the negative-conversion group. The outcome was radiographic progression, namely, increased number of involved lung areas or cavitary formation. Results. Among 126 patients with MAC-LD, 75 (60%) were in the MAC-PP group; these patients had a higher proportion of radiographic progression (54%) than patients in the negative-conversion group (odds ratio [OR], 3.318; 95% confidence interval, 1.146-9.612). Independent predictors of MAC-PP were low body mass index (BMI), radiographic nodular-bronchiectatic (NB) pattern, and increase in the highest grade of acid-fast bacilli smear (AFS). Patients with BMI <21 kg/m2, NB pattern, and positive AFS had an OR of 17.7 for MAC-PP, and those with ?2 of the factors had a 4.5-fold increased OR for MAC-PP relative to the comparison group. Other than MAC-PP, the highest AFS grade and no anti-MAC treatment were correlated with radiographic progression. Conclusion. Microbiological persistence in patients with MAC-LD is not uncommon and leads to an increased risk of radiographic progression. The predictors of MAC-PP are low BMI, NB pattern, and high AFS grade; if these risk factors are present, anti- MAC treatment should be seriously considered. ? The Author 2017.
SDGs
Other Subjects
tuberculostatic agent; antiinfective agent; adult; antibiotic therapy; Article; atypical mycobacteriosis; bacterium culture; body mass; chronic obstructive lung disease; coughing; diabetes mellitus; dyspnea; female; follow up; hemoptysis; human; lung infection; major clinical study; male; malignant neoplasm; medical record review; Mycobacterium avium complex; nonhuman; priority journal; retrospective study; sputum culture; thorax radiography; Youden index; aged; atypical mycobacteriosis; bronchiectasis; chronic disease; diagnostic imaging; disease exacerbation; lung disease; microbiology; middle aged; risk factor; sputum; very elderly; Aged; Aged, 80 and over; Anti-Bacterial Agents; Body Mass Index; Bronchiectasis; Chronic Disease; Disease Progression; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Radiography, Thoracic; Retrospective Studies; Risk Factors; Sputum
Publisher
Oxford University Press
Type
journal article