Novant Health Pediatric Pulmonology, Novant Health Hemby Children's Hospital, Charlotte, NC, USA.
Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
BMC Infect Dis. 2018 Jul 6;18(1):311. doi: 10.1186/s12879-018-3200-z.
Nontuberculous mycobacteria (NTM) infections in patients with cystic fibrosis (CF) is increasing globally. However, the related epidemiology, comorbidities, and clinical impact of NTM infection remains unclear in the progress of CF lung disease and patient survival.
We performed a retrospective, case-control, cohort study (10 years), comparing NTM culture-positive CF patients (N = 28) to matched controls (N = 26). NTM positive patients were divided in to two groups of slow-growing (N = 17) and rapid- growing NTM (N = 8). Three patients were positive for both slow and rapid NTM. For independent group comparisons, a non-parametric Mann-Whitney test (Kruskal-Wallis test for more than two groups) was used to compare the continuous variables, and a Fisher's exact test was used for the categorical variables. Paired comparisons were performed using a Wilcoxon signed-rank test.
The prevalence of NTM isolation was 8%. The age at CF diagnosis was significantly lower in the slow-growing NTM group compared to the rapidly growing NTM group (P = 0.04). The median percent predicted forced expiratory flow of 25% - 75% (FEF25-75) was significantly higher before NTM acquisition in slow-growing (P = 0.013) and rapidly growing NTM group (P = 0.028). The slow-growing NTM group received significantly more penicillin/beta lactamase (P = 0.010) and rifampin (P = 0.042) following isolation. Macrolide use was significantly higher after isolation in both the slow-growing NTM (P = 0.018) and rapidly growing NTM groups (P = 0.042).
An earlier CF diagnosis was associated with a higher isolation of slow-growing NTM and greater antimicrobial use after infection. NTM acquisition is associated with a worsening of FEF25-75. Thus, both the early diagnosis and treatment of an NTM infection in patients with CF may positively impact lung function.
非结核分枝杆菌（NTM）感染在囊性纤维化（CF）患者中全球范围内呈上升趋势。然而，在 CF 肺部疾病进展和患者生存中，NTM 感染的相关流行病学、合并症和临床影响仍不清楚。
我们进行了一项回顾性病例对照队列研究（10 年），将 NTM 培养阳性 CF 患者（N=28）与匹配对照（N=26）进行比较。NTM 阳性患者分为生长缓慢（N=17）和快速生长 NTM（N=8）两组。有 3 例患者同时对缓慢和快速 NTM 呈阳性。对于独立组比较，使用非参数 Mann-Whitney 检验（Kruskal-Wallis 检验用于超过两组）比较连续变量，使用 Fisher 确切检验比较分类变量。使用 Wilcoxon 符号秩检验进行配对比较。
NTM 分离的患病率为 8%。与快速生长 NTM 组相比，生长缓慢 NTM 组 CF 诊断时的年龄明显较小（P=0.04）。在获得 NTM 之前，生长缓慢（P=0.013）和快速生长 NTM 组（P=0.028）的 25%至 75%预计用力呼气流量（FEF25-75）百分比明显更高。在分离后，生长缓慢的 NTM 组接受了更多的青霉素/β内酰胺酶（P=0.010）和利福平（P=0.042）。在生长缓慢的 NTM （P=0.018）和快速生长 NTM 组（P=0.042）中，在分离后大环内酯类药物的使用明显更高。
早期 CF 诊断与生长缓慢的 NTM 更高的分离率和感染后更多的抗菌药物使用相关。NTM 获得与 FEF25-75 的恶化相关。因此，CF 患者中 NTM 感染的早期诊断和治疗可能对肺功能产生积极影响。
