Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease.

Journal Article (Journal Article)

BACKGROUND: The increasing global prevalence of pulmonary nontuberculous mycobacteria (NTM) disease has called attention to challenges in NTM diagnosis and management. This study was conducted to understand management and outcomes of patients with pulmonary NTM disease at diverse centers across the United States. METHODS: We conducted a 10-year (2005-2015) retrospective study at 7 Vaccine and Treatment Evaluation Units to evaluate pulmonary NTM treatment outcomes in human immunodeficiency virus-negative adults. Demographic and clinical information was abstracted through medical record review. Microbiologic and clinical cure were evaluated using previously defined criteria. RESULTS: Of 297 patients diagnosed with pulmonary NTM, the most frequent NTM species were Mycobacterium avium-intracellulare complex (83.2%), M. kansasii (7.7%), and M. abscessus (3.4%). Two hundred forty-five (82.5%) patients received treatment, while 45 (15.2%) were followed without treatment. Eighty-six patients had available drug susceptibility results; of these, >40% exhibited resistance to rifampin, ethambutol, or amikacin. Of the 138 patients with adequate outcome data, 78 (56.5%) experienced clinical and/or microbiologic cure. Adherence to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) treatment guidelines was significantly more common in patients who were cured (odds ratio, 4.5, 95% confidence interval, 2.0-10.4; Pā€…<ā€….001). Overall mortality was 15.7%. CONCLUSIONS: Despite ATS/IDSA Guidelines, management of pulmonary NTM disease was heterogeneous and cure rates were relatively low. Further work is required to understand which patients are suitable for monitoring without treatment and the impact of antimicrobial therapy on pulmonary NTM morbidity and mortality.

Full Text

Duke Authors

Cited Authors

  • Abate, G; Stapleton, JT; Rouphael, N; Creech, B; Stout, JE; El Sahly, HM; Jackson, L; Leyva, FJ; Tomashek, KM; Tibbals, M; Watson, N; Miller, A; Charbek, E; Siegner, J; Sokol-Anderson, M; Nayak, R; Dahlberg, G; Winokur, P; Alaaeddine, G; Beydoun, N; Sokolow, K; Kown, NP; Phillips, S; Baker, AW; Turner, N; Walter, E; Guy, E; Frey, S

Published Date

  • April 8, 2021

Published In

Volume / Issue

  • 72 / 7

Start / End Page

  • 1127 - 1137

PubMed ID

  • 32198521

Pubmed Central ID

  • PMC8028102

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

Digital Object Identifier (DOI)

  • 10.1093/cid/ciaa252


  • eng

Conference Location

  • United States