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Long-Term Treatment Outcome of Progressive Mycobacterium Avium Complex Pulmonary Disease.


ABSTRACT: BACKGROUND:Multidrug therapy is essential for preventing respiratory failure in patients with highly progressive Mycobacterium avium complex pulmonary disease (MAC-PD). However, the prognosis and long-term outcome following combination therapy is poorly understood. METHODS:We retrospectively evaluated the clinical characteristics and long-term outcomes in patients with chemo-naïve progressive MAC-PD, hospitalized for first-line multidrug therapy. RESULTS:Among 125 patients, 86 (68.8%) received standardized treatment (rifampicin, ethambutol, clarithromycin), 25 (20.0%) received a fluoroquinolone (FQ)-containing regimen, and 53 (42.4%) received aminoglycoside injection. The sputum conversion rate was 80.0%, and was independently associated with standardized treatment. The incidence of refractory disease (45.6%) was independently and negatively associated with standardized regimen and aminoglycoside use. Choice of an FQ-containing regimen was not associated with positive outcome. Clarithromycin resistance occurred in 16.8% and was independently associated with refractory disease. MAC-PD-associated death occurred in 3.3% of patients with non-cavitary nodular bronchiectasis (NB) and 21.3% with cavitary MAC-PD over a median follow-up period of 56.4 months. The rates of MAC-PD-associated death were comparable between cavitary-NB and fibrocavitary disease. Concurrent chronic pulmonary aspergillosis (CPA) occurred in 13 (17.3%) patients with cavitary MAC-PD, and age, diabetes mellitus, and CPA were independent risk factors for mortality. CONCLUSIONS:Standardized intensive multidrug treatment reduces disease progression and persistence in progressive MAC-PD. Cavitary NB may differ from, rather than being just an advanced stage of, non-cavitary NB. The high incidence and significant mortality of CPA in cavitary MAC-PD highlight the need for early diagnosis and treatment.

SUBMITTER: Fukushima K 

PROVIDER: S-EPMC7291046 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Long-Term Treatment Outcome of Progressive <i>Mycobacterium Avium</i> Complex Pulmonary Disease.

Fukushima Kiyoharu K   Kitada Seigo S   Abe Yuko Y   Yamamoto Yuji Y   Matsuki Takanori T   Kagawa Hiroyuki H   Oshitani Yohei Y   Tsujino Kazuyuki K   Yoshimura Kenji K   Miki Mari M   Miki Keisuke K   Kida Hiroshi H  

Journal of clinical medicine 20200502 5


<h4>Background</h4>Multidrug therapy is essential for preventing respiratory failure in patients with highly progressive <i>Mycobacterium avium</i> complex pulmonary disease (MAC-PD). However, the prognosis and long-term outcome following combination therapy is poorly understood.<h4>Methods</h4>We retrospectively evaluated the clinical characteristics and long-term outcomes in patients with chemo-naïve progressive MAC-PD, hospitalized for first-line multidrug therapy.<h4>Results</h4>Among 125 pa  ...[more]

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