Factors which influence treatment initiation for pulmonary non-tuberculous mycobacterium infection in HIV negative patients; a multicentre observational study

Respir Med. 2016 Nov:120:101-108. doi: 10.1016/j.rmed.2016.10.001. Epub 2016 Oct 6.

Abstract

Background: Clinical, radiological and microbiological criteria inform diagnosis of pulmonary Non-Tuberculous Mycobacteria (NTM) disease and treatment decisions. This multicentre, review aims to characterise NTM disease meeting ATS/IDSA criteria and define factors associated with initiation of treatment.

Methods: Sputum samples growing NTM from 5 London hospitals between 2010 and 2014 were identified. Data for HIV-negative individuals meeting ATS/IDSA guidelines for pulmonary NTM disease were extracted. Associations between clinical variables and treatment decision were investigated using Chi-squared, Fishers-exact or Mann Whitney tests. Factors associated with treatment in univariate analysis (p < 0.150) were included in a multivariate logistic regression model.

Results: NTM were identified from 817 individuals' sputum samples. 108 met ATS/IDSA criteria. 42/108 (39%) were initiated on treatment. Median age was 68 (56-78) in the cohort. On multivariate analysis, factors significantly associated with treatment of pulmonary NTM infection were: Cavitation on HRCT (OR: 6.49; 95% CI: 2.36-17.81), presenting with night sweats (OR 4.18; 95% CI: 1.08-16.13), and presenting with weight loss (OR 3.02; 95% CI: 1.15-7.93). Of those treated, 18(43%) have completed treatment, 9(21%) remain on treatment, 10(24%) stopped due to side effects, 5(12%) died during treatment. Mortality was 31% (n = 13) in treated versus 21% (n = 14) in the non-treated cohort. Subgroup analysis of individual NTM species did not observe any differences in treatment initiation or outcomes between groups.

Discussion: Decision to treat pulmonary NTM infection requires clinical judgement when interpreting clinical guidelines. Factors independently associated with decision to treat in this HIV-negative cohort include cavitation on HRCT and presenting with night sweats or weight loss.

Keywords: Anti-mycobacterial chemotherapy; Epidemiology; Factors influencing treatment; HIV-Negative; Non-tuberculous mycobacterium.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Cohort Studies
  • Decision Making
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Seronegativity / drug effects*
  • Humans
  • London / epidemiology
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / drug therapy
  • Lung Diseases / epidemiology
  • Lung Diseases / microbiology*
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / diagnostic imaging
  • Mycobacterium Infections, Nontuberculous / drug therapy*
  • Mycobacterium Infections, Nontuberculous / epidemiology
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Mycobacterium kansasii / drug effects
  • Mycobacterium kansasii / isolation & purification
  • Mycobacterium xenopi / drug effects
  • Mycobacterium xenopi / isolation & purification
  • Nontuberculous Mycobacteria / isolation & purification*
  • Prevalence
  • Retrospective Studies
  • Sputum / microbiology
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • United Kingdom

Substances

  • Anti-Bacterial Agents