Abstract
BackgroundMacrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little data in clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MAC-PD).MethodsWe performed a systematic review and meta-analysis of published studies reporting clinical characteristics and treatment outcomes of patients with MR-MAC-PD. Risk of bias was assessed using the modified Newcastle-Ottawa Scale.ResultsNine studies (seven retrospective and two prospective) comprising 319 patients were identified through a database search. Around 73% were women, and 52% had the fibrocavitary form. Pooled sputum culture conversion rate after combined multiple antibiotics or surgical resection was 21% (95% confidence interval [CI], 14–30%), and the one-year all-cause mortality was 10% (95% CI, 5–20%). There was no significant difference in treatment outcomes between nodular bronchiectatic and fibrocavitary types.ConclusionsEven combination therapy with fluoroquinolone, aminoglycoside, and surgical resection, the treatment outcomes of MR-MAC-PD were poor. The investigation of new treatment modalities is urgent.
Highlights
Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MACPD)
A few studies with a limited number of patients have evaluated the clinical characteristics and treatment outcomes of macrolide-resistant MAC pulmonary disease (MAC-PD) (MR-MACPD), and the results were inconsistent in terms of risk factors and optimal treatment modalities
MAC isolates with a clarithromycin minimal inhibitory concentration ≥ 32 μg/mL in the broth microdilution method were defined as macrolide-resistant
Summary
Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MACPD). Mycobacterium avium complex (MAC), mainly comprising M. avium and M. intracellulare, has been reported as the most common etiology of NTM pulmonary disease in many countries such as North America and East Asia [3]. Macrolides, such as clarithromycin and azithromycin, are indispensable to the antibiotic treatment of MAC pulmonary disease (MAC-PD). A few studies with a limited number of patients have evaluated the clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MACPD), and the results were inconsistent in terms of risk factors and optimal treatment modalities.
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