Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Infectious Diseases, Laboratory of Clinical Microbiology, Mexico City, Mexico.
Braz J Infect Dis. 2020 May-Jun;24(3):213-220. doi: 10.1016/j.bjid.2020.04.012. Epub 2020 May 16.
Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections.
We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM).
A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p=0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p=0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p=0.27).
Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
非结核分枝杆菌（NTM）包括多种具有复杂毒力谱、不同流行病学和临床模式以及宿主特异性的病原体。最近，观察到 NTM 感染数量增加；因此，本研究的目的是评估这些感染的临床特征和结局。
我们纳入了 2001-2017 年间 NTM 感染患者，并获得了危险因素、临床特征和结局；最后，我们比较了慢生长菌（SGM）和快生长菌（RGM）之间的数据。
共评估了 230 例患者，158 例（69%）感染，72 例（31%）定植/假感染。研究前 11 年的平均年发病率为每 1000 例住院患者 0.5 例，之后增加到每 1000 例住院患者 2.0 例。NTM 感染的分布如下：血流和播散性疾病 72 例（45%），肺部感染 67 例（42%），皮肤和软组织感染 19 例（12%）。SGM 感染中最常见的分离株是鸟分枝杆菌复合体，受感染的患者大多为 HIV 感染者。在 RGM 感染中，M. fortuitum 是最常见的分离株，主要发生于存在癌症、2 型糖尿病、有侵袭性装置和使用免疫抑制治疗等基础疾病的患者中。我们未发现播散性 SGM 感染与播散性 RGM 感染之间的死亡率和持续性感染差异有统计学意义（42%比 24%，p=0.22）。然而，播散性 SGM 感染的治疗时间长于播散性 RGM 感染（中位数，210 天比 42 天，p=0.01）。NTM 肺部疾病中，治疗与未治疗患者的结局无显著差异（p=0.27）。
我们的结果显示，在我们的研究环境中，非结核分枝杆菌感染的数量显著增加。慢生长分枝杆菌感染的患者主要是人类免疫缺陷病毒感染者。患有慢性疾病的老年患者是快生长分枝杆菌感染的常见人群。对于非结核分枝杆菌肺部感染，抗生素治疗应个体化。
