Zomer Domenique, van Ingen Jakko, Hofland Regina
Dutch CF Foundation, Dr. A. Schweitzerweg 3a, 3744 MG Baarn, the Netherlands.
Radboudumc Center for Infectious Diseases, Dept. of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
J Cyst Fibros. 2023 Mar;22(2):327-333. doi: 10.1016/j.jcf.2022.10.009. Epub 2022 Nov 6.
Nontuberculous mycobacteria (NTM) are opportunistic, difficult to treat pathogens. With increasing prevalence of NTM infections in people with cystic fibrosis (pwCF) and the improved life expectancy, the burden is expected to grow.
We assessed the epidemiology and management of NTM isolation and disease in pwCF in the Netherlands using a survey and retrospective, case-controlled data from the Dutch CF Registry. We determined the isolation prevalence, treatment and outcomes from 2013-2019.
NTM isolation prevalence increased from 1.0% to 3.6% (2013-2019). This was a single NTM isolation in 53.7% of the adults and 60.0% of the children. M. abscessus and M. avium complex (MAC) were most frequent (47.1 and 30.9%). Of the treated pwCF, 48.5% attained culture conversion of M. abscessus; 54.5% for MAC. Children with an NTM isolation showed more infections with S. maltophilia and/or A. fumigatus (p < 0.001) compared to controls. In the year prior to NTM isolation, children in the NTM group had a lower mean FEV1% predicted (81.5 ± 16.7 vs. 88.6 ± 15.3, p = 0.024), while adults in the NTM group had more IV antibiotic days compared to controls (60 vs. 17, p = 0.047). In the following years, FEV1% predicted declined faster in pwCF with NTM than the control group (children: -3.8% vs. -1.6%, p = 0.023; adults: -0.7% and 0.4%, ns).
The isolation prevalence of 3.6%, poor treatment outcomes and associated lung function decline emphasize that NTM pulmonary disease (NTM-PD) is a significant health issue among pwCF in the Netherlands. Its prevention and treatment require increased attention.
非结核分枝杆菌（NTM）是机会性致病且难以治疗的病原体。随着囊性纤维化患者（pwCF）中NTM感染患病率的上升以及预期寿命的延长，预计负担将会增加。
我们通过一项调查以及荷兰囊性纤维化注册中心的回顾性病例对照数据，评估了荷兰pwCF中NTM分离株及疾病的流行病学和管理情况。我们确定了2013 - 2019年的分离患病率、治疗情况及结果。
NTM分离患病率从1.0%增至3.6%（2013 - 2019年）。在成人中，53.7%以及在儿童中60.0%的情况为单一NTM分离株。脓肿分枝杆菌和鸟分枝杆菌复合群（MAC）最为常见（分别为47.1%和30.9%）。在接受治疗的pwCF中，48.5%的脓肿分枝杆菌实现了培养转阴；MAC为54.5%。与对照组相比，NTM分离株阳性的儿童嗜麦芽窄食单胞菌和/或烟曲霉感染更多（p < 0.001）。在NTM分离前一年，NTM组儿童的预计FEV1%较低（81.5 ± 16.7 vs. 88.6 ± 15.3，p = 0.024），而NTM组成人使用静脉抗生素的天数比对照组更多（60天 vs. 17天，p = 0.047）。在随后几年中，NTM阳性的pwCF患者预计FEV1%的下降速度比对照组更快（儿童：-3.8% vs. -1.6%，p = 0.023；成人：-0.7%和0.4%，无显著差异）。
3.6%的分离患病率、较差的治疗结果以及相关的肺功能下降强调了NTM肺病（NTM - PD）是荷兰pwCF中一个重要的健康问题。其预防和治疗需要更多关注。
