Abstract
Infectious diseases caused by nontuberculous mycobacteria (NTM) are increasingly common. This retrospective cohort study examined factors associated with outcomes in patients from Shanghai who had NTM pulmonary disease (NTMPD) from January 2014 to December 2018. The causative bacterial species, drug susceptibility test results, treatment outcomes, sputum culture conversion rate, and risk factors associated with treatment failure were determined. The most common species were Mycobacterium avium complex (MAC) (50%), M. abscessus (28%), and M. kansasii (15%). Over five years, the proportions of M. kansasii and M. abscessus increased, and that of MAC decreased. The treatment success rate was significantly greater for patients infected with M. kansasii (89.9%) than MAC (65.0%, p < 0.001) and M. abscessus (36.1%, p < 0.001). Multivariate analysis indicated the risk factors for treatment failure were pathogenic NTM species (M. abscessus: aOR = 9.355, p < 0.001; MAC: aOR = 2.970, p < 0.001), elevated ESR (>60 mm/h: aOR = 2.658, p < 0.001), receipt of retreatment (aOR = 2.074, p < 0.001), and being middle-aged or elderly (>60 years-old: aOR = 1.739, p = 0.021; 45–60 years-old: aOR = 1.661, p = 0.034). The main bacterial species responsible for NTMPD were MAC, M. abscessus, and M. kansasii. Patients who were infected by M. abscessus or MAC, with elevated ESR, received retreatment, and were middle-aged or elderly had an increased risk of treatment failure.
Highlights
Accepted: 9 February 2022Infection by nontuberculous mycobacteria (NTM) has become a major public health problem in many geographical regions [1–3]
We systematically investigated the incidence, causative bacterial species, drug susceptibility test results, treatment outcomes, sputum culture conversion rate, and risk factors associated with treatment failure
We identified the causative species as M. intracellulare (542, 43%), M. abscessus (357, 28%), M. kansasii (185, 15%), M. avium (86, 7%), other NTM species (56, 4%), and mixed infections (37, 3%)
Summary
Infection by nontuberculous mycobacteria (NTM) has become a major public health problem in many geographical regions [1–3]. Data from previous epidemiological surveys of tuberculosis (TB) in China showed that the rate of NTM isolation was 4.3% in 1979, 11.1% in 2000, and 22.9% in 2010. There are more than 200 known NTM species worldwide, most of which are parasitic bacteria, only a few are pathogenic to humans. The common pathogenic NTM species are Mycobacterium avium complex (MAC), M. abscessus, M. kansasii, and M. xenopi [4]. The different NTM species vary in their geographical distributions [5,6]. MAC, M. abscessus, M. fortuitum, and M. kansasii are commonly reported in the Pacific region [7]. China has a heavy burden of NTM diseases
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