Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Clin Infect Dis. 2017 Feb 1;64(3):301-308. doi: 10.1093/cid/ciw723. Epub 2016 Nov 10.
Mycobacterium abscessus and Mycobacterium massiliense are grouped as the Mycobacterium abscessus complex. The aim of this study was to elucidate the differences between M. abscessus and M. massiliense lung diseases in terms of progression rate, treatment outcome, and the predictors thereof.
Between 1 January 2006 and 30 June 2015, 56 patients and 54 patients were diagnosed with M. abscessus and M. massiliense lung diseases, respectively. The time to progression requiring treatment and treatment outcomes were compared between the 2 groups of patients, and predictors of progression and sustained culture conversion with treatment were analyzed. In addition, mediation analysis was performed to evaluate the effect of susceptibility to clarithromycin on treatment outcomes.
During follow-up, 21 of 56 patients with M. abscessus lung diseases and 21 of 54 patients with M. massiliense lung diseases progressed, requiring treatment. No difference was detected in the time to progression between the 2 patient groups. Lower body mass index, bilateral lung involvement, and fibrocavitary-type disease were identified as predictors of disease progression. Among the patients who began treatment, infection with M. massiliense rather than M. abscessus and the use of azithromycin rather than clarithromycin were associated with sustained culture conversion. The difference in treatment outcomes was partly mediated by the organism's susceptibility to clarithromycin.
Progression rates were similar but treatment outcomes differed significantly between patients with lung disease caused by M. abscessus and M. massiliense. This difference in treatment outcomes was partly explained by the susceptibility of these organisms to clarithromycin.
脓肿分枝杆菌和马赛分枝杆菌被归为脓肿分枝杆菌复合体。本研究旨在阐明在进展速度、治疗结果及其预测因素方面，脓肿分枝杆菌和马赛分枝杆菌肺病之间的差异。
2006 年 1 月 1 日至 2015 年 6 月 30 日期间，分别诊断了 56 例和 54 例患有脓肿分枝杆菌和马赛分枝杆菌肺病的患者。比较了两组患者需要治疗的进展时间和治疗结果，并分析了进展和持续培养转化的预测因素。此外，还进行了中介分析，以评估克拉霉素敏感性对治疗结果的影响。
在随访期间，56 例脓肿分枝杆菌肺病患者中有 21 例和 54 例马赛分枝杆菌肺病患者中有 21 例进展，需要治疗。两组患者的进展时间无差异。较低的体重指数、双肺受累和纤维空洞型疾病被确定为疾病进展的预测因素。在开始治疗的患者中，感染的分枝杆菌是马赛分枝杆菌而非脓肿分枝杆菌，以及使用的是阿奇霉素而非克拉霉素，与持续培养转化有关。治疗结果的差异部分由病原体对克拉霉素的敏感性所介导。
脓肿分枝杆菌和马赛分枝杆菌肺病患者的进展速度相似，但治疗结果存在显著差异。这种治疗结果的差异部分解释了这些生物体对克拉霉素的敏感性。
