Outcomes of Mycobacterium avium complex lung disease based on clinical phenotype

• Published in: The European respiratory journal Vol. 50; no. 3; p. 1602503
• Main Authors: Koh, Won-Jung, Moon, Seong Mi, Kim, Su-Young, Woo, Min-Ah, Kim, Seonwoo, Jhun, Byung Woo, Park, Hye Yun, Jeon, Kyeongman, Huh, Hee Jae, Ki, Chang-Seok, Lee, Nam Yong, Chung, Myung Jin, Lee, Kyung Soo, Shin, Sung Jae, Daley, Charles L, Kim, Hojoong, Kwon, O Jung
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society Journals Ltd 01.09.2017
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Cohort Studies; Databases, Factual; Drug Therapy, Combination; Female; Genotype & phenotype; Genotyping; Humans; Kaplan-Meier Estimate; Logistic Models; Lung - drug effects; Lung - microbiology; Lung diseases; Lung Diseases - microbiology; Lung Diseases - physiopathology; Male; Middle Aged; Mycobacterium avium; Mycobacterium avium Complex - drug effects; Mycobacterium avium Complex - genetics; Mycobacterium avium Complex - growth & development; Mycobacterium Infections, Nontuberculous - drug therapy; Mycobacterium Infections, Nontuberculous - microbiology; Phenotype; Recurrence; Republic of Korea; Risk Factors; Treatment Outcome
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/13993003.02503-2016

The effect of the clinical phenotype of complex (MAC) lung disease on treatment outcome and redevelopment of nontuberculous mycobacterial (NTM) lung disease after treatment completion has not been studied systematically.We evaluated 481 treatment-naïve patients with MAC lung disease who underwent antibiotic treatment for ≥12 months between January 2002 and December 2013.Out of 481 patients, 278 (58%) had noncavitary nodular bronchiectatic (NB) disease, 80 (17%) had cavitary NB disease and 123 (25%) had fibrocavitary disease. Favourable outcome was higher in patients with noncavitary disease (88%) than in patients with cavitary disease (76% for fibrocavitary and 78% for cavitary NB disease; p<0.05). Cavitary disease was independently associated with unfavourable outcomes (p<0.05). Out of 402 patients with favourable outcomes, 118 (29%) experienced redevelopment of NTM lung disease, with the same MAC species recurring in 65 (55%) patients. The NB form was an independent risk factor for redevelopment of NTM lung disease (p<0.05). In patients with recurrent MAC lung disease due to the same species, bacterial genotyping revealed that 74% of cases were attributable to reinfection and 26% to relapse.Treatment outcomes and redevelopment of NTM lung disease after treatment completion differed by clinical phenotype of MAC lung disease.