MYCOBACTERIUM ABSCESSUS TREATMENT COMPLEXITY IN ADULT PATIENTS WITH CYSTIC FIBROSIS

Abstract

SESSION TITLE: Tuesday Electronic Posters 1 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: The prevalence of nontuberculous mycobacteria (NTM) in the Cystic Fibrosis (CF) population is increasing, particularly Mycobacterium abscessus complex (MABSC). Pulmonary disease caused by MABSC is a clinical and therapeutic challenge for patients and healthcare providers. We aim to assess the prevalence of MABSC in adults followed by our CF center and the outcomes of treatment. METHODS: A retrospective, cohort study was performed using data obtained from the registry of adult patients with CF at the University of Texas Health San Antonio. The diagnosis of NTM was based on the Infectious Disease Society of America clinical and microbiologic criteria and therapy was dictated by consensus guidelines by the United States CF Foundation and European CF Society. We performed descriptive statistics, including disease prevalence. The primary outcome was whether MABSC appropriate guideline concordant therapy was used. Appropriate therapy for MABSC was defined for two phases: intensive phase (intravenous/oral) and a continuation phase (oral/inhaled). Study end-points include lung transplantation, therapy completion with microbiological eradication and patients currently in the continuation phase. RESULTS: Among all the patients with CF (n=106) and NTM diagnosis (n=28), the prevalence of MABSC (n=8) was 26% and 29% respectively. The average time to initiation of therapy was 5.7 months. Three patients were lost to follow-up (37.5%) and two did not receive the intensive phase of anti-MABSC therapy (25%). First culture negativity was achieved in 6 cases. The intensive and continuation phase was achieved in 75% (n=6) and 62.5% (n=5) of the cases, respectively. Monotherapy with a macrolide or other antimicrobial agents were not used on any of the patients. The most commonly used therapies used in the intensive phase were intravenous (IV) Amikacin, IV Tigecycline, oral (PO) Azithromycin and PO Linezolid. The most commonly used therapies in the continuation phase were PO Linezolid, PO Azithromycin, PO Minocycline and inhaled Amikacin. Treated patients (n=5) had the following therapeutic end-points: lung transplantation (n=1), therapy completion (n=2) and currently on the continuation phase (n=2). CONCLUSIONS: Despite guideline recommendations for the diagnosis and management of MABSC, the actual treatment implementation represents a real challenge due to the ability to follow the patient, tolerance of the medications, achieving culture negativity and consistency in the duration of therapy. CLINICAL IMPLICATIONS: Larger studies should address the complexity related to the management of patients with MABSC infection. Similar challenges should be addressed in treating other NTM infections in CF as well as non-CF populations. DISCLOSURES: no disclosure on file for Sheila Habib; No relevant relationships by Holly Keyt, source=Web Response No relevant relationships by Marcos Restrepo, source=Web Response No relevant relationships by Meilinh Thi, source=Web Response