Department of Medicine, University of Colorado, Denver, CO, United States.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.
J Cyst Fibros. 2020 Jul;19(4):569-574. doi: 10.1016/j.jcf.2020.02.013. Epub 2020 Mar 13.
Current guidelines recommend at least once yearly screening for nontuberculous mycobacteria (NTM) in Cystic Fibrosis (CF), however screening practices remain widely variable. This study evaluates current practices among United States CF centers with specific focus on clinical predictive factors for NTM screening.
The CF Patient Registry (CFFPR) was queried for CF patients ages 10 and older with NTM cultures completed between 2010-2014. Predictors for screening were assessed using univariate and multivariate logistic regression. Centers were evaluated by groups based on screening rates for analysis of clinical drivers of screening.
From 2010-2014 a total of 22,739 patients were identified with 17,177 (75.5%) tested for NTM during this time. In the overall cohort, those who were tested for NTM had lower pulmonary function (70.7% vs 83.9%), higher annual average of visits with pulmonary exacerbations (1.0 vs 0.3), and higher rate of coinfection with Pseudomonas aeruginosa (PA) as well as Methicillin resistant Staphylococcus aureus (MRSA). Among CF centers, pulmonary function, exacerbations, and coinfections with PA and MRSA were predictive of NTM screening in the lower screening cohort while pulmonary function was not predictive of screening in the highest screening cohort. Those programs who screened at a higher rate were successful in identifying NTM in more CF patients.
NTM screening practices vary widely among United States CF centers with many centers testing only on clinical changes. With higher rates of testing shown as successful in identifying more patients with NTM, routine screening should be emphasized in CF care going forward.
目前的指南建议每年至少对囊性纤维化（CF）患者进行一次非结核分枝杆菌（NTM）筛查，但筛查实践仍存在很大差异。本研究评估了美国 CF 中心目前的实践情况，特别关注 NTM 筛查的临床预测因素。
从 2010 年至 2014 年，通过 CF 患者注册（CFFPR）对年龄在 10 岁及以上且完成 NTM 培养的 CF 患者进行了查询。使用单变量和多变量逻辑回归评估了筛查的预测因素。根据筛查率对中心进行分组，以分析筛查的临床驱动因素。
2010 年至 2014 年间，共确定了 22739 名患者，其中 17177 名（75.5%）在此期间接受了 NTM 检测。在整个队列中，接受 NTM 检测的患者肺功能较低（70.7%对 83.9%），每年因肺部感染加重就诊的平均次数较高（1.0 次对 0.3 次），铜绿假单胞菌（PA）和耐甲氧西林金黄色葡萄球菌（MRSA）合并感染的发生率也较高。在 CF 中心中，在较低的筛查队列中，肺功能、感染加重和与 PA 和 MRSA 的合并感染是 NTM 筛查的预测因素，而在最高的筛查队列中，肺功能并不是筛查的预测因素。那些筛查率较高的项目成功地在更多的 CF 患者中发现了 NTM。
美国 CF 中心的 NTM 筛查实践差异很大，许多中心仅在出现临床变化时进行检测。随着检测率的提高，成功地在更多的 NTM 患者中识别出了更多的患者，因此在未来的 CF 护理中应强调常规筛查。
