Abstract
BackgroundThe diagnosis and treatment of patients with bronchiectasis and nontuberculous mycobacterium (NTM) pulmonary disease are challenging issues and the treatment is also prolonged and depends on the species. There is limited information on patients with bronchiectasis and NTM pulmonary disease in Mainland China.MethodsThis cross-sectional study was conducted at the China–Japan Friendship Hospital, Beijing, China. Those adult patients who met the diagnostic criteria for bronchiectasis and obtained a culture result of mycobacteria from lower respiratory tract specimens or lung tissue were included in this study. A logistic regression model was used to identify the related factors in patients with NTM pulmonary disease.ResultsA total of 202 patients with bronchiectasis from 19 cities, 155 without and 47 (23.3%) with NTM pulmonary disease, were included. In all the 47 patients with NTM pulmonary disease, Mycobacterium avium complex was the most common species (66.0%), and 72.3% of them were initiated on standard anti-NTM treatment within 3 months after the diagnosis of NTM pulmonary disease. A larger proportion of patients with NTM pulmonary disease had acute exacerbations of ≥ 3 times within 1 year and were diagnosed bronchiectasis ≥ 50 years among patients with NTM pulmonary disease. The HRCT chest images revealed higher proportions of nodular shadow (100% vs. 35.3%), tree-in-bud sign (97.9% vs. 29.0%), cavities (29.8% vs. 5.8%), and airway dilation of the right middle lobe or the left lingular lobe (63.8% vs. 23.9%) in patients with NTM pulmonary disease than in those without NTM pulmonary disease (all P values = 0.001). The multivariable logistic regression model indicated that three and more abnormal features (OR 33.8; 95% CI 11.1–102.8) and main lesions of bronchial expansion in the middle or lingual lobe (OR 6.4; 95% CI 2.4–16.6) in HRCT chest images were independently associated with NTM pulmonary disease (P values = 0.001).ConclusionIn a single center of Mainland China, > 23% of patients with bronchiectasis had NTM pulmonary disease, and most patients were started on standard treatment within 3 months after the diagnosis of NTM pulmonary disease. These findings suggest that patients with bronchiectasis should be thoroughly examined for the presence of NTM pulmonary disease.Trial registrationNCT03594032.
Highlights
The diagnosis and treatment of patients with bronchiectasis and nontuberculous mycobacterium (NTM) pulmonary disease are challenging issues and the treatment is prolonged and depends on the species
23.3% of the patients were diagnosed with NTM diseases, and 72.3% (34/47) were started on standard treatment within 3 months after the diagnosis of NTM pulmonary disease (Initial antimicrobial therapy: Clarithromycin, rifampicin and ethambutol in patients with Mycobacterium avium complex (MAC)-PD or M. kansasii –PD; Amikacin, Cefoxitin, macrolide and fluoroquinolone in patients with M. abscessus/M. chelonae-PD)
Associated factors of bronchiectasis with NTM pulmonary disease We used univariable and multivariable logistic regression models to evaluate the possible associated factors and found that more than three thoracic high-resolution computed tomography (HRCT) abnormalities of imaging features and bronchiectasis main lesions in the middle or lingual lobe were independently associated with NTM pulmonary disease
Summary
The diagnosis and treatment of patients with bronchiectasis and nontuberculous mycobacterium (NTM) pulmonary disease are challenging issues and the treatment is prolonged and depends on the species. Bronchiectasis accompanied with positive isolation of Pseudomonas aeruginosa has been associated with worsening lung function, increased frequencies of acute exacerbations, and poor prognosis [1, 4,5,6]. Detection of Aspergillus fumigatus in the airways of patients with bronchiectasis is associated with risks for severe disease, worse lung function, and acute exacerbations [8]. Over the past 10 years, the issue of whether the nontuberculous mycobacterium (NTM) pulmonary disease was hospital-acquired or community-acquired had been an interesting research question in the clinical investigations of patients with bronchiectasis [9,10,11,12,13]
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