Knoll B M, Kappagoda S, Gill R R, Goldberg H J, Boyle K, Baden L R, Fuhlbrigge A L, Marty F M
Division of Infectious Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Transpl Infect Dis. 2012 Oct;14(5):452-60. doi: 10.1111/j.1399-3062.2012.00753.x. Epub 2012 Jun 8.
The incidence of infection with non-tuberculous mycobacteria (NTM) after lung transplant is insufficiently defined. Data on the impact of NTM infection on lung transplant survival are conflicting.
To quantify the incidence and outcomes of colonization and disease with NTM in patients after lung transplantation, the medical records, chest imaging, and microbiology data of 237 consecutive lung transplant recipients between 1990 and 2005 were reviewed. American Thoracic Society (ATS)/Infectious Diseases Society of America and Centers for Disease Control criteria were used to define pulmonary NTM disease and NTM surgical-site infections (SSI), respectively. Incidence rates for NTM colonization and disease were calculated. Comparisons of median survival were done using the log-rank test.
NTM were isolated from 53 of 237 patients (22.4%) after lung transplantation over a median of 25.2 months of follow-up. The incidence rate of NTM isolation was 9.0/100 person-years (95% confidence interval [CI), 6.8-11.8), and the incidence rate of NTM disease was 1.1/100 person-years (95% CI 0.49-2.2). The most common NTM isolated was Mycobacterium avium complex (69.8%), followed by Mycobacterium abscessus (9.4%), and Mycobacterium gordonae (7.5%). Among these 53 patients, only 2 patients met ATS criteria for pulmonary disease and received treatment for M. avium. One patient had recurrent colonization after treatment, the other one was cured. Four of the 53 patients developed SSI, 3 caused by M. abscessus and 1 caused by Mycobacterium chelonae. Three of these patients had persistent infection requiring chronic suppressive therapy and one died from progressive disseminated disease. A total of 47 (89%) patients who met microbiologic but not radiographic criteria for pulmonary infection were not treated and were found to have only transient colonization. Median survival after transplantation was not different between patients with transient colonization who did not receive treatment and those who never had NTM isolated.
Episodic isolation of NTM from lung transplant recipients is common. Most isolates occur among asymptomatic patients and are transient. Rapidly growing NTM can cause significant SSI, which may be difficult to cure. NTM disease rate is higher among lung transplant recipients than in the general population. In this cohort, NTM isolation was not associated with increased post-transplantation mortality.
肺移植后非结核分枝杆菌（NTM）感染的发生率尚未明确界定。关于NTM感染对肺移植存活影响的数据存在矛盾。
为了量化肺移植患者NTM定植和疾病的发生率及转归，回顾了1990年至2005年间连续237例肺移植受者的病历、胸部影像学和微生物学数据。分别采用美国胸科学会（ATS）/美国感染病学会和疾病控制中心的标准来定义肺部NTM疾病和NTM手术部位感染（SSI）。计算NTM定植和疾病的发生率。使用对数秩检验对中位生存期进行比较。
在中位随访25.2个月期间，237例肺移植患者中有53例（22.4%）分离出NTM。NTM分离的发生率为9.0/100人年（95%置信区间[CI]，6.8 - 11.8），NTM疾病的发生率为1.1/100人年（95%CI 0.49 - 2.2）。分离出的最常见NTM是鸟分枝杆菌复合体（69.8%），其次是脓肿分枝杆菌（9.4%）和戈登分枝杆菌（7.5%）。在这53例患者中，只有2例符合ATS肺部疾病标准并接受了鸟分枝杆菌治疗。1例患者治疗后复发定植，另1例治愈。53例患者中有4例发生SSI，3例由脓肿分枝杆菌引起，1例由龟分枝杆菌引起。其中3例患者有持续感染需要长期抑制治疗，1例死于播散性疾病。共有47例（89%）符合肺部感染微生物学但不符合影像学标准的患者未接受治疗，发现仅有短暂定植。未接受治疗的短暂定植患者与从未分离出NTM的患者移植后的中位生存期无差异。
肺移植受者间歇性分离出NTM很常见。大多数分离情况发生在无症状患者中且是短暂的。快速生长的NTM可导致严重的SSI，可能难以治愈。肺移植受者的NTM疾病发生率高于一般人群。在该队列中，NTM分离与移植后死亡率增加无关。
