Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Centro de Referencia Helio Fraga, Escola Nacional de Saúde Pública, FIOCRUZ, Rio de Janeiro, Brazil.
Eur Respir J. 2019 Jul 11;54(1). doi: 10.1183/13993003.01991-2018. Print 2019 Jul.
Treatment of pulmonary disease (MAB-PD), caused by subsp. , subsp. or subsp. , is challenging.We conducted an individual patient data meta-analysis based on studies reporting treatment outcomes for MAB-PD to clarify treatment outcomes for MAB-PD and the impact of each drug on treatment outcomes. Treatment success was defined as culture conversion for ≥12 months while on treatment or sustained culture conversion without relapse until the end of treatment.Among 14 eligible studies, datasets from eight studies were provided and a total of 303 patients with MAB-PD were included in the analysis. The treatment success rate across all patients with MAB-PD was 45.6%. The specific treatment success rates were 33.0% for subsp. and 56.7% for subsp. For MAB-PD overall, the use of imipenem was associated with treatment success (adjusted odds ratio (aOR) 2.65, 95% CI 1.36-5.10). For patients with subsp. , the use of azithromycin (aOR 3.29, 95% CI 1.26-8.62), parenteral amikacin (aOR 1.44, 95% CI 1.05-1.99) or imipenem (aOR 7.96, 95% CI 1.52-41.6) was related to treatment success. For patients with subsp. , the choice among these drugs was not associated with treatment outcomes.Treatment outcomes for MAB-PD are unsatisfactory. The use of azithromycin, amikacin or imipenem was associated with better outcomes for patients with subsp. .
治疗由 亚种、亚种或亚种引起的肺部疾病（MAB-PD）具有挑战性。我们进行了一项基于报告 MAB-PD 治疗结果的研究的个体患者数据荟萃分析，以阐明 MAB-PD 的治疗结果以及每种药物对治疗结果的影响。治疗成功定义为治疗期间培养物转化≥12 个月或直至治疗结束时持续培养物转化且无复发。在 14 项合格研究中，提供了 8 项研究的数据集，共有 303 例 MAB-PD 患者纳入分析。所有 MAB-PD 患者的治疗成功率为 45.6%。亚种的具体治疗成功率为 33.0%，亚种的治疗成功率为 56.7%。对于 MAB-PD 整体，使用亚胺培南与治疗成功相关（调整后的优势比（aOR）2.65，95%置信区间（CI）1.36-5.10）。对于亚种患者，使用阿奇霉素（aOR 3.29，95%CI 1.26-8.62）、注射用阿米卡星（aOR 1.44，95%CI 1.05-1.99）或亚胺培南（aOR 7.96，95%CI 1.52-41.6）与治疗成功相关。对于亚种患者，这些药物的选择与治疗结果无关。MAB-PD 的治疗结果不理想。阿奇霉素、阿米卡星或亚胺培南的使用与亚种患者的更好结果相关。
