Treatment and Clinical Course of Patients With Pulmonary Nontuberculous Mycobacteria Negative for Human Immunodeficiency Virus
| . | All (N = 297) . | MAC (n = 247) . | M. kansasii (n = 23) . | M. abscessus (n = 12) . | Other (n = 7) . | Multiple (n = 8) . |
|---|---|---|---|---|---|---|
| Treated | 245 (83.1) | 203 (82.9) | 21 (91.3) | 9 (75) | 6 (85.7) | 6 (75) |
| No. of antibiotics administered as initial therapy | ||||||
| 1 | 10a (4.1) | 8 (3.9) | … | 2 (22.2) | … | … |
| 2 | 26 (10.6) | 22 (10.8) | 1 (4.8) | 2 (22.2) | 1 (16.7) | … |
| ≥3 | 210 (85.4) | 174 (85.3) | 20 (95.2) | 5 (55.6) | 5 (83.3) | 6 (100) |
| Mode of initial antibiotics administration | ||||||
| Oral only | 229 (93.1) | 192 (94.1) | 21 (100) | 4 (44.4) | 6 (100) | 6 (100) |
| Oral and parenteral | 17 (6.9) | 12 (5.9) | … | 5 (55.6) | … | … |
| Duration of treatment, mean ± SD, m | 13.7 ± 9.7 | 13.7 ± 10.0 | 13.6 ± 8.0 | 13.4 ± 12.2 | 17.2 ± 3.3 | 10.9 ± 7.3 |
| Adherence to ATS/IDSA treatment guidelines | 99 (33) | 88 (35.6) | 4 (17.4) | 2 (16.7) | 1 (14.3) | 3 (37.5) |
| Change in treatment | 97 (32.7) | 80 (32.4) | 5 (21.7) | 7 (58.3) | 2 (28.6) | 3 (37.5) |
| Reason for discontinued treatment | ||||||
| Persistent positive culture | 12 (7.5) | 12 (9.3) | … | … | … | … |
| Culture-confirmed drug resistance | 9 (5.7) | 9 (7) | … | … | … | … |
| Adverse drug effects | 90 (56.6) | 75 (58.1) | 3 (23.1) | 6 (85.7) | 1 (25) | 5 (83.3) |
| Drug interaction | 3 (1.9) | 2 (1.6) | … | … | … | 1 (16.7) |
| NTM culture result available at follow-up | ||||||
| 12–24 m | 141 (47.5) | 114 (46.2) | 11 (47.8) | 9 (75) | 3 (42.9) | 4 (50) |
| 24–30 m | 66 (22.2) | 56 (22.7) | 1 (4.3) | 5 (41.7) | 2 (28.6) | 2 (25) |
| >30 m | 41 (13.8) | 35 (14.2) | 3 (13) | 2 (16.7) | … | 1 (12.5) |
| NTM culture negative at follow-up | ||||||
| 12–24 m | 88 (62.4) | 70 (61.4) | 11 (100) | 3 (33.3) | 2 (66.7) | 2 (50) |
| 24–30 m | 36 (54.5) | 30 (53.6) | 1 (100) | 3 (60) | 1 (50) | 1 (50) |
| >30 m | 22 (53.7) | 18 (51.4) | 2 (66.7) | 2 (100) | … | … |
| Symptoms improvement | ||||||
| 3 m | 104 (44.6) | 85 (43.4) | 11 (68.8) | 4 (50) | 2 (33.3) | 2 (28.6) |
| 6 m | 76 (41.3) | 66 (41.3) | 5 (50) | 3 (42.9) | 2 (66.7) | … |
| 9 m | 69 (41.1) | 65 (44.8) | 2 (20) | 1 (14.3) | 1 (25) | … |
| 12 m | 55 (34.6) | 49 (34.5) | 4 (50) | 1 (25) | … | 1 (25) |
| 18 m | 75 (36.2) | 66 (38.2) | 6 (37.5) | … | 2 (40) | 1 (20) |
| 30 m | 50 (29.6) | 42 (28.8) | 3 (37.5) | 3 (42.9) | … | 2 (40) |
| Hospitalization | 83 (29.2) | 62 (26.3) | 9 (40.9) | 6 (50) | 3 (50) | 3 (37.5) |
| Died | 44 (15.7) | 34 (14.7) | 4 (18.2) | 4 (33.3) | … | 2 (25) |
| Total person-years follow-up | 506 | 428 | 32 | 21 | 12 | 13 |
| Months of follow-up, median (IQR) | 24.2(14.5, 29.7) | 24.8(15.0, 29.7) | 17.5(13.8, 24.0) | 26.1(14.4, 29.8) | 24.4(20.7, 29.9) | 23.4(9.0, 29.5) |
| . | All (N = 297) . | MAC (n = 247) . | M. kansasii (n = 23) . | M. abscessus (n = 12) . | Other (n = 7) . | Multiple (n = 8) . |
|---|---|---|---|---|---|---|
| Treated | 245 (83.1) | 203 (82.9) | 21 (91.3) | 9 (75) | 6 (85.7) | 6 (75) |
| No. of antibiotics administered as initial therapy | ||||||
| 1 | 10a (4.1) | 8 (3.9) | … | 2 (22.2) | … | … |
| 2 | 26 (10.6) | 22 (10.8) | 1 (4.8) | 2 (22.2) | 1 (16.7) | … |
| ≥3 | 210 (85.4) | 174 (85.3) | 20 (95.2) | 5 (55.6) | 5 (83.3) | 6 (100) |
| Mode of initial antibiotics administration | ||||||
| Oral only | 229 (93.1) | 192 (94.1) | 21 (100) | 4 (44.4) | 6 (100) | 6 (100) |
| Oral and parenteral | 17 (6.9) | 12 (5.9) | … | 5 (55.6) | … | … |
| Duration of treatment, mean ± SD, m | 13.7 ± 9.7 | 13.7 ± 10.0 | 13.6 ± 8.0 | 13.4 ± 12.2 | 17.2 ± 3.3 | 10.9 ± 7.3 |
| Adherence to ATS/IDSA treatment guidelines | 99 (33) | 88 (35.6) | 4 (17.4) | 2 (16.7) | 1 (14.3) | 3 (37.5) |
| Change in treatment | 97 (32.7) | 80 (32.4) | 5 (21.7) | 7 (58.3) | 2 (28.6) | 3 (37.5) |
| Reason for discontinued treatment | ||||||
| Persistent positive culture | 12 (7.5) | 12 (9.3) | … | … | … | … |
| Culture-confirmed drug resistance | 9 (5.7) | 9 (7) | … | … | … | … |
| Adverse drug effects | 90 (56.6) | 75 (58.1) | 3 (23.1) | 6 (85.7) | 1 (25) | 5 (83.3) |
| Drug interaction | 3 (1.9) | 2 (1.6) | … | … | … | 1 (16.7) |
| NTM culture result available at follow-up | ||||||
| 12–24 m | 141 (47.5) | 114 (46.2) | 11 (47.8) | 9 (75) | 3 (42.9) | 4 (50) |
| 24–30 m | 66 (22.2) | 56 (22.7) | 1 (4.3) | 5 (41.7) | 2 (28.6) | 2 (25) |
| >30 m | 41 (13.8) | 35 (14.2) | 3 (13) | 2 (16.7) | … | 1 (12.5) |
| NTM culture negative at follow-up | ||||||
| 12–24 m | 88 (62.4) | 70 (61.4) | 11 (100) | 3 (33.3) | 2 (66.7) | 2 (50) |
| 24–30 m | 36 (54.5) | 30 (53.6) | 1 (100) | 3 (60) | 1 (50) | 1 (50) |
| >30 m | 22 (53.7) | 18 (51.4) | 2 (66.7) | 2 (100) | … | … |
| Symptoms improvement | ||||||
| 3 m | 104 (44.6) | 85 (43.4) | 11 (68.8) | 4 (50) | 2 (33.3) | 2 (28.6) |
| 6 m | 76 (41.3) | 66 (41.3) | 5 (50) | 3 (42.9) | 2 (66.7) | … |
| 9 m | 69 (41.1) | 65 (44.8) | 2 (20) | 1 (14.3) | 1 (25) | … |
| 12 m | 55 (34.6) | 49 (34.5) | 4 (50) | 1 (25) | … | 1 (25) |
| 18 m | 75 (36.2) | 66 (38.2) | 6 (37.5) | … | 2 (40) | 1 (20) |
| 30 m | 50 (29.6) | 42 (28.8) | 3 (37.5) | 3 (42.9) | … | 2 (40) |
| Hospitalization | 83 (29.2) | 62 (26.3) | 9 (40.9) | 6 (50) | 3 (50) | 3 (37.5) |
| Died | 44 (15.7) | 34 (14.7) | 4 (18.2) | 4 (33.3) | … | 2 (25) |
| Total person-years follow-up | 506 | 428 | 32 | 21 | 12 | 13 |
| Months of follow-up, median (IQR) | 24.2(14.5, 29.7) | 24.8(15.0, 29.7) | 17.5(13.8, 24.0) | 26.1(14.4, 29.8) | 24.4(20.7, 29.9) | 23.4(9.0, 29.5) |
Data are presented as n (%) unless otherwise indicated.
Abbreviations: ATS/IDSA, American Thoracic Society/Infectious Diseases Society of America; IQR, interquartile range; MAC, Mycobacterium avium-intracellulare complex; NTM, nontuberculous mycobacteria.
aSix received macrolide alone and four received doxycycline, levofloxacin, tobramycin or vancomycin.
Treatment and Clinical Course of Patients With Pulmonary Nontuberculous Mycobacteria Negative for Human Immunodeficiency Virus
| . | All (N = 297) . | MAC (n = 247) . | M. kansasii (n = 23) . | M. abscessus (n = 12) . | Other (n = 7) . | Multiple (n = 8) . |
|---|---|---|---|---|---|---|
| Treated | 245 (83.1) | 203 (82.9) | 21 (91.3) | 9 (75) | 6 (85.7) | 6 (75) |
| No. of antibiotics administered as initial therapy | ||||||
| 1 | 10a (4.1) | 8 (3.9) | … | 2 (22.2) | … | … |
| 2 | 26 (10.6) | 22 (10.8) | 1 (4.8) | 2 (22.2) | 1 (16.7) | … |
| ≥3 | 210 (85.4) | 174 (85.3) | 20 (95.2) | 5 (55.6) | 5 (83.3) | 6 (100) |
| Mode of initial antibiotics administration | ||||||
| Oral only | 229 (93.1) | 192 (94.1) | 21 (100) | 4 (44.4) | 6 (100) | 6 (100) |
| Oral and parenteral | 17 (6.9) | 12 (5.9) | … | 5 (55.6) | … | … |
| Duration of treatment, mean ± SD, m | 13.7 ± 9.7 | 13.7 ± 10.0 | 13.6 ± 8.0 | 13.4 ± 12.2 | 17.2 ± 3.3 | 10.9 ± 7.3 |
| Adherence to ATS/IDSA treatment guidelines | 99 (33) | 88 (35.6) | 4 (17.4) | 2 (16.7) | 1 (14.3) | 3 (37.5) |
| Change in treatment | 97 (32.7) | 80 (32.4) | 5 (21.7) | 7 (58.3) | 2 (28.6) | 3 (37.5) |
| Reason for discontinued treatment | ||||||
| Persistent positive culture | 12 (7.5) | 12 (9.3) | … | … | … | … |
| Culture-confirmed drug resistance | 9 (5.7) | 9 (7) | … | … | … | … |
| Adverse drug effects | 90 (56.6) | 75 (58.1) | 3 (23.1) | 6 (85.7) | 1 (25) | 5 (83.3) |
| Drug interaction | 3 (1.9) | 2 (1.6) | … | … | … | 1 (16.7) |
| NTM culture result available at follow-up | ||||||
| 12–24 m | 141 (47.5) | 114 (46.2) | 11 (47.8) | 9 (75) | 3 (42.9) | 4 (50) |
| 24–30 m | 66 (22.2) | 56 (22.7) | 1 (4.3) | 5 (41.7) | 2 (28.6) | 2 (25) |
| >30 m | 41 (13.8) | 35 (14.2) | 3 (13) | 2 (16.7) | … | 1 (12.5) |
| NTM culture negative at follow-up | ||||||
| 12–24 m | 88 (62.4) | 70 (61.4) | 11 (100) | 3 (33.3) | 2 (66.7) | 2 (50) |
| 24–30 m | 36 (54.5) | 30 (53.6) | 1 (100) | 3 (60) | 1 (50) | 1 (50) |
| >30 m | 22 (53.7) | 18 (51.4) | 2 (66.7) | 2 (100) | … | … |
| Symptoms improvement | ||||||
| 3 m | 104 (44.6) | 85 (43.4) | 11 (68.8) | 4 (50) | 2 (33.3) | 2 (28.6) |
| 6 m | 76 (41.3) | 66 (41.3) | 5 (50) | 3 (42.9) | 2 (66.7) | … |
| 9 m | 69 (41.1) | 65 (44.8) | 2 (20) | 1 (14.3) | 1 (25) | … |
| 12 m | 55 (34.6) | 49 (34.5) | 4 (50) | 1 (25) | … | 1 (25) |
| 18 m | 75 (36.2) | 66 (38.2) | 6 (37.5) | … | 2 (40) | 1 (20) |
| 30 m | 50 (29.6) | 42 (28.8) | 3 (37.5) | 3 (42.9) | … | 2 (40) |
| Hospitalization | 83 (29.2) | 62 (26.3) | 9 (40.9) | 6 (50) | 3 (50) | 3 (37.5) |
| Died | 44 (15.7) | 34 (14.7) | 4 (18.2) | 4 (33.3) | … | 2 (25) |
| Total person-years follow-up | 506 | 428 | 32 | 21 | 12 | 13 |
| Months of follow-up, median (IQR) | 24.2(14.5, 29.7) | 24.8(15.0, 29.7) | 17.5(13.8, 24.0) | 26.1(14.4, 29.8) | 24.4(20.7, 29.9) | 23.4(9.0, 29.5) |
| . | All (N = 297) . | MAC (n = 247) . | M. kansasii (n = 23) . | M. abscessus (n = 12) . | Other (n = 7) . | Multiple (n = 8) . |
|---|---|---|---|---|---|---|
| Treated | 245 (83.1) | 203 (82.9) | 21 (91.3) | 9 (75) | 6 (85.7) | 6 (75) |
| No. of antibiotics administered as initial therapy | ||||||
| 1 | 10a (4.1) | 8 (3.9) | … | 2 (22.2) | … | … |
| 2 | 26 (10.6) | 22 (10.8) | 1 (4.8) | 2 (22.2) | 1 (16.7) | … |
| ≥3 | 210 (85.4) | 174 (85.3) | 20 (95.2) | 5 (55.6) | 5 (83.3) | 6 (100) |
| Mode of initial antibiotics administration | ||||||
| Oral only | 229 (93.1) | 192 (94.1) | 21 (100) | 4 (44.4) | 6 (100) | 6 (100) |
| Oral and parenteral | 17 (6.9) | 12 (5.9) | … | 5 (55.6) | … | … |
| Duration of treatment, mean ± SD, m | 13.7 ± 9.7 | 13.7 ± 10.0 | 13.6 ± 8.0 | 13.4 ± 12.2 | 17.2 ± 3.3 | 10.9 ± 7.3 |
| Adherence to ATS/IDSA treatment guidelines | 99 (33) | 88 (35.6) | 4 (17.4) | 2 (16.7) | 1 (14.3) | 3 (37.5) |
| Change in treatment | 97 (32.7) | 80 (32.4) | 5 (21.7) | 7 (58.3) | 2 (28.6) | 3 (37.5) |
| Reason for discontinued treatment | ||||||
| Persistent positive culture | 12 (7.5) | 12 (9.3) | … | … | … | … |
| Culture-confirmed drug resistance | 9 (5.7) | 9 (7) | … | … | … | … |
| Adverse drug effects | 90 (56.6) | 75 (58.1) | 3 (23.1) | 6 (85.7) | 1 (25) | 5 (83.3) |
| Drug interaction | 3 (1.9) | 2 (1.6) | … | … | … | 1 (16.7) |
| NTM culture result available at follow-up | ||||||
| 12–24 m | 141 (47.5) | 114 (46.2) | 11 (47.8) | 9 (75) | 3 (42.9) | 4 (50) |
| 24–30 m | 66 (22.2) | 56 (22.7) | 1 (4.3) | 5 (41.7) | 2 (28.6) | 2 (25) |
| >30 m | 41 (13.8) | 35 (14.2) | 3 (13) | 2 (16.7) | … | 1 (12.5) |
| NTM culture negative at follow-up | ||||||
| 12–24 m | 88 (62.4) | 70 (61.4) | 11 (100) | 3 (33.3) | 2 (66.7) | 2 (50) |
| 24–30 m | 36 (54.5) | 30 (53.6) | 1 (100) | 3 (60) | 1 (50) | 1 (50) |
| >30 m | 22 (53.7) | 18 (51.4) | 2 (66.7) | 2 (100) | … | … |
| Symptoms improvement | ||||||
| 3 m | 104 (44.6) | 85 (43.4) | 11 (68.8) | 4 (50) | 2 (33.3) | 2 (28.6) |
| 6 m | 76 (41.3) | 66 (41.3) | 5 (50) | 3 (42.9) | 2 (66.7) | … |
| 9 m | 69 (41.1) | 65 (44.8) | 2 (20) | 1 (14.3) | 1 (25) | … |
| 12 m | 55 (34.6) | 49 (34.5) | 4 (50) | 1 (25) | … | 1 (25) |
| 18 m | 75 (36.2) | 66 (38.2) | 6 (37.5) | … | 2 (40) | 1 (20) |
| 30 m | 50 (29.6) | 42 (28.8) | 3 (37.5) | 3 (42.9) | … | 2 (40) |
| Hospitalization | 83 (29.2) | 62 (26.3) | 9 (40.9) | 6 (50) | 3 (50) | 3 (37.5) |
| Died | 44 (15.7) | 34 (14.7) | 4 (18.2) | 4 (33.3) | … | 2 (25) |
| Total person-years follow-up | 506 | 428 | 32 | 21 | 12 | 13 |
| Months of follow-up, median (IQR) | 24.2(14.5, 29.7) | 24.8(15.0, 29.7) | 17.5(13.8, 24.0) | 26.1(14.4, 29.8) | 24.4(20.7, 29.9) | 23.4(9.0, 29.5) |
Data are presented as n (%) unless otherwise indicated.
Abbreviations: ATS/IDSA, American Thoracic Society/Infectious Diseases Society of America; IQR, interquartile range; MAC, Mycobacterium avium-intracellulare complex; NTM, nontuberculous mycobacteria.
aSix received macrolide alone and four received doxycycline, levofloxacin, tobramycin or vancomycin.
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