Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Antimicrob Agents Chemother. 2018 Jan 25;62(2). doi: 10.1128/AAC.01812-17. Print 2018 Feb.
Intermittent, three-times-weekly oral antibiotic therapy is recommended for the initial treatment of noncavitary nodular bronchiectatic (NB) complex (MAC) lung disease. However, intermittent therapy is not recommended for patients who have been previously treated. We evaluated 53 patients with recurrent noncavitary NB MAC lung disease who underwent antibiotic treatment for ≥12 months with daily therapy ( = 26) or intermittent therapy ( = 27) between January 2008 and December 2015. Baseline characteristics were comparable between daily therapy and intermittent therapy groups. Sputum culture conversion rates did not differ between daily therapy (21/26, 81%) and intermittent therapy (22/27, 82%) groups. Compared to the etiologic organism at the time of previous treatment, recurrent MAC lung disease was caused by the same MAC species in 38 patients (72%) and by a different MAC species in 15 patients (28%). Genotype analysis in patients with sequenced paired isolates revealed that 86% (12/14) of cases with same species recurrence were due to reinfection with a new MAC genotype. In conclusion, most recurrent noncavitary NB MAC lung disease cases were caused by reinfection rather than relapse. Intermittent antibiotic therapy is a reasonable treatment strategy for recurrent noncavitary NB MAC lung disease.
对于非囊性结节性支气管扩张（NB）复合（MAC）肺部疾病的初始治疗，建议采用间歇性、每周三次的口服抗生素治疗。然而，对于既往接受过治疗的患者，不建议采用间歇性治疗。我们评估了 2008 年 1 月至 2015 年 12 月期间，53 例接受了≥12 个月每日治疗（n=26）或间歇性治疗（n=27）的复发性非囊性 NB MAC 肺部疾病患者的抗生素治疗。每日治疗组和间歇性治疗组的基线特征无差异。痰培养转换率在每日治疗组（21/26，81%）和间歇性治疗组（22/27，82%）之间无差异。与既往治疗时的病原体相比，38 例（72%）复发性 MAC 肺部疾病由相同的 MAC 种引起，15 例（28%）由不同的 MAC 种引起。对有测序配对分离株的患者进行基因分析显示，86%（12/14）同一种 MAC 种复发的病例是由于新的 MAC 基因型再感染引起的。总之，大多数复发性非囊性 NB MAC 肺部疾病病例是由再感染引起的，而不是复发。间歇性抗生素治疗是复发性非囊性 NB MAC 肺部疾病的合理治疗策略。
