Nontuberculous mycobacterial disease managed within UK primary care, 2006\u20132016

Eleanor L Axson,Jennifer K Quint,Chloe I Bloom

doi:10.1007/s10096-018-3315-6

Abstract

Previous UK studies investigating nontuberculous mycobacteria have been limited to reporting isolation from culture, not burden of disease. We assessed the burden of nontuberculous mycobacterial disease (NTMD) in UK primary care from 2006 to 2016. Using electronic healthcare records, we identified patients with NTMD using a strict definition including patients with guideline-directed treatment/monitoring. We described treatment regimens and incidence/prevalence in the general population and in patients with underlying chronic respiratory diseases. Incidence of primary care-managed NTMD in the general population decreased (2006 to 2016 rates per 100,000 person-years, 3.85 to 1.28). Average annual prevalence of NTMD in the general population was 6.38 per 100,000. Around 85% were taking antimycobacterial therapy; 53.2% were taking a guideline-recommended regimen. Incidence of NTMD in patients with respiratory disease decreased (2006 to 2016 rates per 100,000 person-years, 12.5 to 7.40). Average annual prevalence of NTMD in patients with respiratory disease was 27.7 per 100,000. This is the first UK study using nationally representative data to investigate the burden of NTMD managed within primary care. Incidence and prevalence of managed NTMD within primary care is gradually declining. Increasing complexity in the management of NTMD may be driving a shift in care to secondary settings.

Highlights

Nontuberculous mycobacteria (NTM) are opportunistic bacterial pathogens [1,2,3,4]
Of those being treated for NTM disease (NTMD) in primary care, 572 (53.2%) were taking a multi-drug regimen recommended by British Thoracic Society guidelines (BTS00) [12], ATS07 [1], and/or British Thoracic Society guidelines (BTS17) [2] (Table 3)
Without detailed secondary care and microbiology data, it cannot be known whether a shift in NTMD management from primary to secondary care has occurred, other findings support our hypothesis [3, 34]. This is the first nationally representative UK study to investigate the clinical burden of NTMD managed within primary care

Summary

Introduction

Some populations are more susceptible to infection with NTM, chronic respiratory disease (CRD) patients [3, 5,6,7,8]. The most common clinical manifestation of NTM disease (NTMD) is lung disease [2]. Previous studies have found that patients with chronic obstructive pulmonary. National guidelines for the treatment of NTMD have changed over time and significant differences in recommended therapies were seen between the two major guidelines available during our study period [1, 12]. The new British Thoracic Society 2017 guidelines [2] have explicitly recommend specialist management of NTMD, unlike previous guidelines [1, 12]

Methods

Results

Discussion

Conclusion