Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Antimicrob Agents Chemother. 2018 Sep 24;62(10). doi: 10.1128/AAC.00491-18. Print 2018 Oct.
Although it is known that the MICs of rifampin and ethambutol are poorly correlated with the clinical response in complex (MAC) lung disease (MAC-LD), evidence for this is limited. This study investigated the association between treatment outcome and the MICs of rifampin and ethambutol in patients with MAC-LD. Among patients diagnosed with macrolide-susceptible MAC-LD between January 2008 and December 2013, 274 patients who were treated with a standard regimen for ≥12 months until August 2017 and whose MIC results were available were enrolled at a tertiary referral center in South Korea. The MICs of antimicrobial agents were determined using the broth microdilution method. The mean age of the included patients was 60.4 years. The overall treatment success rate was 79.6% (218/274 patients) and tended to decrease with increasing MICs of rifampin and ethambutol, particularly at MICs of ≥8 μg/ml. Treatment success rate was significantly different between MAC isolates with MICs of ≥8 μg/ml for rifampin and ethambutol and those with MICs of <8 μg/ml for rifampin and/or ethambutol (64.9% versus 85.3%, < 0.001). Multivariate analysis showed that an MIC of ≥8 μg/ml for both drugs and initial sputum acid-fast bacillus (AFB) smear positivity were independent risk factors for an unfavorable response (adjusted odds ratio [OR] = 3.154, 95% confidence interval [CI] = 1.641 to 6.063, and = 0.001 for an MIC of ≥8 μg/ml; adjusted OR = 2.769, 95% CI = 1.420 to 5.399, and = 0.003 for initial sputum AFB smear positivity). These findings suggest that the MICs of rifampin and ethambutol may be related to treatment outcome in MAC-LD.
虽然已知利福平（rifampin）和乙胺丁醇（ethambutol）的 MIC 与复杂（MAC）肺病（MAC-LD）的临床反应相关性较差，但这方面的证据有限。本研究旨在探讨 MAC-LD 患者的治疗结果与利福平（rifampin）和乙胺丁醇（ethambutol）MIC 之间的关系。在 2008 年 1 月至 2013 年 12 月期间，在韩国的一家三级转诊中心诊断为大环内酯类药物敏感 MAC-LD 的患者中，共纳入了 274 名接受标准方案治疗（≥12 个月）并于 2017 年 8 月前获得 MIC 结果的患者。采用肉汤微量稀释法测定抗菌药物的 MIC。纳入患者的平均年龄为 60.4 岁。总的治疗成功率为 79.6%（218/274 例患者），且随着利福平（rifampin）和乙胺丁醇（ethambutol）MIC 的升高而呈下降趋势，尤其是在 MIC 升高至≥8μg/ml 时。利福平（rifampin）和/或乙胺丁醇（ethambutol）MIC≥8μg/ml 组的 MAC 分离株与 MIC＜8μg/ml 组相比，治疗成功率存在显著差异（64.9%与 85.3%，＜0.001）。多变量分析显示，两种药物的 MIC≥8μg/ml 和初始痰抗酸杆菌（AFB）涂片阳性是治疗效果不佳的独立危险因素（调整后的比值比[OR] = 3.154，95%置信区间[CI] = 1.641 至 6.063，P＜0.001；调整后的 OR = 2.769，95% CI = 1.420 至 5.399，P = 0.003）。这些发现提示利福平（rifampin）和乙胺丁醇（ethambutol）的 MIC 可能与 MAC-LD 的治疗结果有关。
