Olivier Kenneth N, Shaw Pamela A, Glaser Tanya S, Bhattacharyya Darshana, Fleshner Michelle, Brewer Carmen C, Zalewski Christopher K, Folio Les R, Siegelman Jenifer R, Shallom Shamira, Park In Kwon, Sampaio Elizabeth P, Zelazny Adrian M, Holland Steven M, Prevots D Rebecca
1 Laboratory of Clinical Infectious Diseases.
Ann Am Thorac Soc. 2014 Jan;11(1):30-5. doi: 10.1513/AnnalsATS.201307-231OC.
Treatment of pulmonary nontuberculous mycobacteria, especially Mycobacterium abscessus, requires prolonged, multidrug regimens with high toxicity and suboptimal efficacy. Options for refractory disease are limited.
We reviewed the efficacy and toxicity of inhaled amikacin in patients with treatment-refractory nontuberculous mycobacterial lung disease.
Records were queried to identify patients who had inhaled amikacin added to failing regimens. Lower airway microbiology, symptoms, and computed tomography scan changes were assessed together with reported toxicity.
The majority (80%) of the 20 patients who met entry criteria were women; all had bronchiectasis, two had cystic fibrosis and one had primary ciliary dyskinesia. At initiation of inhaled amikacin, 15 were culture positive for M. abscessus and 5 for Mycobacterium avium complex and had received a median (range) of 60 (6, 190) months of mycobacterial treatment. Patients were followed for a median of 19 (1, 50) months. Eight (40%) patients had at least one negative culture and 5 (25%) had persistently negative cultures. A decrease in smear quantity was noted in 9 of 20 (45%) and in mycobacterial culture growth for 10 of 19 (53%). Symptom scores improved in nine (45%), were unchanged in seven (35%), and worsened in four (20%). Improvement on computed tomography scans was noted in 6 (30%), unchanged in 3 (15%), and worsened in 11 (55%). Seven (35%) stopped amikacin due to: ototoxicity in two (10%), hemoptysis in two (10%), and nephrotoxicity, persistent dysphonia, and vertigo in one each.
In some patients with treatment-refractory pulmonary nontuberculous mycobacterial disease, the addition of inhaled amikacin was associated with microbiologic and/or symptomatic improvement; however, toxicity was common. Prospective evaluation of inhaled amikacin for mycobacterial disease is warranted.
治疗肺部非结核分枝杆菌，尤其是脓肿分枝杆菌，需要长期使用多药联合方案，这些方案毒性高且疗效欠佳。针对难治性疾病的选择有限。
我们回顾了吸入阿米卡星对治疗难治性非结核分枝杆菌肺病患者的疗效和毒性。
查询记录以确定在失败方案中添加了吸入阿米卡星的患者。评估下呼吸道微生物学、症状以及计算机断层扫描变化，并报告毒性情况。
符合入选标准的20例患者中，大多数（80%）为女性；均患有支气管扩张症，2例患有囊性纤维化，1例患有原发性纤毛运动障碍。开始吸入阿米卡星治疗时，15例脓肿分枝杆菌培养呈阳性，5例鸟分枝杆菌复合群培养呈阳性，且接受抗分枝杆菌治疗的中位时间（范围）为60（6，190）个月。患者的中位随访时间为19（1，50）个月。8例（40%）患者至少有一次培养结果为阴性，5例（25%）患者培养结果持续为阴性。20例中有9例（45%）涂片数量减少，19例中有10例（53%）分枝杆菌培养生长减少。9例（45%）患者症状评分改善，7例（35%）患者症状评分无变化，4例（20%）患者症状评分恶化。6例（30%）患者计算机断层扫描显示有改善，3例（15%）患者无变化，11例（55%）患者病情恶化。7例（35%）患者因以下原因停用阿米卡星：2例（10%）出现耳毒性，2例（10%）出现咯血，各有1例出现肾毒性、持续性声音嘶哑和眩晕。
在一些治疗难治性肺部非结核分枝杆菌病患者中，添加吸入阿米卡星与微生物学和/或症状改善相关；然而，毒性反应较为常见。有必要对吸入阿米卡星治疗分枝杆菌病进行前瞻性评估。
