多重细菌培养阳性反映了分枝杆菌复合群肺病支气管扩张症的严重程度和预后。

Multiple bacterial culture positivity reflects the severity and prognosis as bronchiectasis in Mycobacterium avium complex pulmonary disease.

机构信息

Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.

Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan; Department of Basic Mycobacteriosis, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

出版信息

Respir Med. 2023 Nov-Dec;219:107417. doi: 10.1016/j.rmed.2023.107417. Epub 2023 Sep 28.

DOI:10.1016/j.rmed.2023.107417

PMID:37775085

Abstract

BACKGROUND

Bacterial coinfections are observed in 19-66% of patients with Mycobacterium avium complex pulmonary disease (MAC-PD) during the entire duration of the disease. The impact of bacterial coinfection at diagnosis on the clinical course of MAC-PD has not been reported.

METHODS

Among 558 patients diagnosed with MAC-PD between January 2016 and December 2020, 218 patients who underwent sputum culture tests twice or more within one year before and after diagnosis were included. We compared the patient characteristics and disease courses between the patients who had the same bacterial species detected twice or more (bacterial culture positive group: BCP group) and those who never had bacteria cultured (bacterial culture negative group: BCN group).

RESULTS

We included 70 patients in the BCP group and 74 in the BCN group. The radiological findings showed that BCP at diagnosis correlated with a high modified Reiff score. During the median follow-up period of 42 months, the patients in the BCP group were more likely to accomplish spontaneous sputum conversion of MAC. The treatment initiation rate for MAC-PD in the BCP group was lower than that in the BCN group (41.4% vs. 67.6%, P = 0.003). In contrast, the time to the first bronchiectasis exacerbation in the BCP group was shorter than that in the BCN group, and the frequency of bronchiectasis exacerbations was higher in the BCP group.

CONCLUSIONS

Patients with BCP at diagnosis are less likely to initiate treatment for MAC-PD and more likely to develop bronchiectasis exacerbation.

摘要

背景

分枝杆菌复合群肺病（MAC-PD）患者在整个疾病过程中，19-66%会发生细菌合并感染。细菌合并感染在诊断时对 MAC-PD 临床病程的影响尚未报道。

方法

在 2016 年 1 月至 2020 年 12 月期间诊断为 MAC-PD 的 558 例患者中，纳入了 218 例在诊断前和诊断后 1 年内进行了两次或更多次痰培养试验的患者。我们比较了两次或更多次检测到相同细菌（细菌培养阳性组：BCP 组）和从未培养出细菌的患者（细菌培养阴性组：BCN 组）的患者特征和疾病过程。

结果

我们纳入了 70 例 BCP 组患者和 74 例 BCN 组患者。影像学检查结果显示，BCP 组患者在诊断时的改良 Reiff 评分较高。在 42 个月的中位随访期间，BCP 组患者更有可能实现 MAC 的自发痰转化。BCP 组患者开始治疗 MAC-PD 的比例低于 BCN 组（41.4% vs. 67.6%，P=0.003）。相反，BCP 组患者首次发生支气管扩张症恶化的时间短于 BCN 组，且 BCP 组患者的支气管扩张症恶化频率更高。