Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea.
Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
Respir Res. 2019 Dec 18;20(1):286. doi: 10.1186/s12931-019-1258-9.
Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little data in clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MAC-PD).
We performed a systematic review and meta-analysis of published studies reporting clinical characteristics and treatment outcomes of patients with MR-MAC-PD. Risk of bias was assessed using the modified Newcastle-Ottawa Scale.
Nine studies (seven retrospective and two prospective) comprising 319 patients were identified through a database search. Around 73% were women, and 52% had the fibrocavitary form. Pooled sputum culture conversion rate after combined multiple antibiotics or surgical resection was 21% (95% confidence interval [CI], 14-30%), and the one-year all-cause mortality was 10% (95% CI, 5-20%). There was no significant difference in treatment outcomes between nodular bronchiectatic and fibrocavitary types.
Even combination therapy with fluoroquinolone, aminoglycoside, and surgical resection, the treatment outcomes of MR-MAC-PD were poor. The investigation of new treatment modalities is urgent.
大环内酯类是治疗鸟分枝杆菌复合群肺部疾病（MAC-PD）的关键药物。大环内酯类耐药 MAC 日益受到重视，但关于大环内酯类耐药 MAC-PD（MR-MAC-PD）的临床特征和治疗结局的数据较少。
我们对报道了 MR-MAC-PD 患者临床特征和治疗结局的已发表研究进行了系统评价和荟萃分析。使用改良的纽卡斯尔-渥太华量表评估偏倚风险。
通过数据库搜索，共确定了 9 项研究（7 项回顾性和 2 项前瞻性），共纳入 319 例患者。约 73%为女性，52%为纤维空洞型。联合使用多种抗生素或手术切除后痰液培养转阴率为 21%（95%可信区间，14-30%），1 年全因死亡率为 10%（95%可信区间，5-20%）。结节性支气管扩张型和纤维空洞型之间的治疗结局无显著差异。
即使联合使用氟喹诺酮类、氨基糖苷类和手术切除，MR-MAC-PD 的治疗结局仍较差。迫切需要探索新的治疗方法。
