Factors associated with acid-fast bacillus isolation in patients with noncystic fibrosis bronchiectasis: A cross-sectional study

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 29; no. 7; pp. 688 - 692
• Main Authors: Takeno, Yukiko, Komiya, Kosaku, Mizukami, Eri, Hiramatsu, Kazufumi, Kadota, Jun-ichi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2023
• Subjects: Acid-fast bacillus; Bacillus; Bronchial wash; Bronchiectasis; Cross-Sectional Studies; Fibrosis; Humans; Lung Diseases, Interstitial; GPL; NTM; Acid-fast bacillus; Bronchiectasis; MDCT; MAC; CT; FVC; FEV1; HRCT; Bronchial wash; AFB; PCR
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2023.03.019

Acid-fast bacillus (AFB) is a major pathogen that causes noncystic fibrosis bronchiectasis requiring multidrug chemotherapy. Bronchoscopic bronchial wash is performed to determine the causative pathogens of bronchiectasis; but, predictive factors for AFB isolation have not been fully elucidated. This study aimed to determine the factors associated with AFB isolation from bronchial wash samples. This was a single-center, cross-sectional study. Patients undergoing bronchoscopic bronchial wash for bronchiectasis were included, whereas those who did not undergo high-resolution computed tomography (HRCT); had acute pneumonia, interstitial lung disease, and a positive polymerase chain reaction result but a negative culture result for AFB; or in whom a guide sheath was used for suspected lung cancer were excluded. Binomial logistic regression was used to analyze the factors associated with a positive culture for AFB. Of the 96 included cases, AFB isolation was observed in the bronchial wash fluid of 26 patients (27%). No smoking history, a positive result for antiglycopeptidolipid (GPL)-core IgA antibody, and the presence of tree-in-bud appearance, multiple granular and nodular images on HRCT were more commonly observed in patients with AFB isolation than in those without. In the multivariate analysis, the tree-in-bud appearance (odds ratio, 4.223; 95% CI, 1.046–17.052) and anti-GPL core IgA antibody (odds ratio, 9.443; 95% CI, 2.206–40.421) were significantly associated with AFB isolation. The tree-in-bud appearance on HRCT is likely to predict AFB isolation independent of anti-GPL core IgA antibody results. Bronchoscopic bronchial wash should be recommended for bronchiectasis with multiple granulomas on HRCT.