Management of patients with pulmonary mycobacteriosis in France: a multicenter retrospective cohort study

Pascale Bémer ,Hélène Guet-Revillet,Christian Carrière,Frédéric Schramm,Anne Vachée,Faïza Mougari,Geneviève Héry-Arnaud,Michèle Pérouse De Montclos,Karine Risso,Marlène Murris,Charlotte Balavoine,Damien Basille,A Bourgoin ,Julien Bador,David Boutoille,Olivia Peuchant,A Guillouzouic ,Marjolaine Georges,F.–X Blanc ,Laurent Raskine,Élodie Blanchard ,T Dégot ,Magali Dupuy-Grasset,C Martin ,Emmanuelle Cambau,Jean-Marie Duez,Sylvain Godreuil,A Lagrange ,F Canis ,Oana Dumitrescu,Gilles Devouassoux,Guillaume Beltramo,C Godet ,Francis Couturaud,Isabelle Patry,Jean‐Michel Vergnon ,Anne Carricajo,S Marchand-Adam ,Christine Segonds,Jean‐Charles Dalphin ,D Sicard ,Didier Caparros,Marion Desquiens,Dominique Terru,Sarah Boulanger,Philippe Lanotte,Alice Gaudart,Farida Hamdad-Daoudi,Christelle Koebel,G Couetdic ,Claire Andréjak

doi:10.1186/s12890-021-01701-5

Abstract

BackgroundRecent studies report very low adherence of practitioners to ATS/IDSA recommendations for the treatment of nontuberculous mycobacteria pulmonary disease (NTM-PD), as well as a great variability of practices. Type of management could impact prognosis.MethodsTo evaluate management and prognosis of patients with NTM-PD cases with respect to ATS recommendations, we conducted a multicenter retrospective cohort study (18 sentinel sites distributed throughout France), over a period of six years. We collected clinical, radiological, microbiological characteristics, management and outcome of the patients (especially death or not).Results477 patients with NTM-PD were included. Respiratory comorbidities were found in 68% of cases, tuberculosis sequelae in 31.4% of patients, and immunosuppression in 16.8% of cases. The three most common NTM species were Mycobacterium avium complex (60%), M. xenopi (20%) and M. kansasii (5.7%). Smear-positive was found in one third of NTM-PD. Nodulobronchiectatic forms were observed in 54.3% of cases, and cavitary forms in 19.1% of patients. Sixty-three percent of patients were treated, 72.4% of patients with smear-positive samples, and 57.5% of patients with smear-negative samples. Treatment was in adequacy with ATS guidelines in 73.5%. The 2-year mortality was 14.4%. In the Cox regression, treatment (HR = 0.51), age (HR = 1.02), and M. abscessus (3.19) appeared as the 3 significant independent prognostic factors.ConclusionThese findings highlight the adequacy between French practices and the ATS/IDSA guidelines. Treatment was associated with a better survival.

Highlights

Recent studies report very low adherence of practitioners to ATS/IDSA recommendations for the treat‐ ment of nontuberculous mycobacteria pulmonary disease (NTM-PD), as well as a great variability of practices
Bemer et al BMC Pulm Med (2021) 21:333. These findings highlight the adequacy between French practices and the ATS/IDSA guidelines
The purpose of this study was to evaluate management and prognosis of French patients with Nontuberculous mycobacteria (NTM)-PD according to the 2007 ATS/IDSA recommendations over a period of six years, from January 2009 to December 2014

Summary

Introduction

Recent studies report very low adherence of practitioners to ATS/IDSA recommendations for the treat‐ ment of nontuberculous mycobacteria pulmonary disease (NTM-PD), as well as a great variability of practices. Nontuberculous mycobacteria pulmonary disease (NTM-PD) is not notifiable in France, as well as in most of the world. The microbiological diagnosis, even insufficient, is essential to make the diagnosis of infection. It is important to follow the recommendations that at least two sputa or one bronchoalveolar lavage be culture-positive to consider microbiological criteria for NTM-PD [1, 2]. It is essential to correctly identify NTM at the species level [3]. The cost of management of NTM-PD has been evaluated four-fold higher than that for matched control, related to hospitalization for 63% and antibiotic treatment for 22% [4]

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Conclusion