Satta Giovanni, McHugh Timothy Daniel, Mountford James, Abubakar Ibrahim, Lipman Marc
1 Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, London, United Kingdom.
Ann Am Thorac Soc. 2014 Jan;11(1):117-21. doi: 10.1513/AnnalsATS.201308-278OT.
The incidence of nontuberculous mycobacteria is increasing worldwide. However, the evidence base for clinical management comprises mostly expert opinion, case series, and few randomized clinical trials. Most currently recommended treatment regimens entail prolonged use of multiple antimicrobial agents associated with multiple self-limited and persistent potential adverse effects, including irreversible impairments of hearing, vision, and kidney function. Yet, little is known about how treatment impacts an individual patient's overall health status. Current treatment guidelines, although of undoubted value, are constrained by these limitations. Here we call for new studies that reassess recommendations for medical management of pulmonary nontuberculous mycobacteria infections, in particular Mycobacterium avium-intracellulare complex and Mycobacterium abscessus complex. We propose pragmatic, person-centered outcome measures that might be used in clinical assessments and new research studies, including patient-reported experience measures and patient-reported outcome measures. This will enable patients and their health-care providers to make clinical management decisions that derive from a realistic view of what they can hope to achieve from treatment.
非结核分枝杆菌在全球的发病率正在上升。然而，临床管理的证据基础主要包括专家意见、病例系列，以及少数随机临床试验。目前大多数推荐的治疗方案需要长期使用多种抗菌药物，这些药物会带来多种自限性和持续性的潜在不良反应，包括听力、视力和肾功能的不可逆损害。然而，对于治疗如何影响个体患者的整体健康状况，我们知之甚少。当前的治疗指南虽然具有毋庸置疑的价值，但也受到这些局限性的制约。在此，我们呼吁开展新的研究，重新评估肺部非结核分枝杆菌感染，特别是鸟分枝杆菌复合群和脓肿分枝杆菌复合群的药物治疗建议。我们提出了务实的、以患者为中心的结局指标，可用于临床评估和新的研究，包括患者报告的体验指标和患者报告的结局指标。这将使患者及其医疗服务提供者能够基于对治疗所能期望达到的效果的现实认识来做出临床管理决策。
