Moon Seong Mi, Cho Hyunkyu, Shin Beomsu
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Tuberc Respir Dis (Seoul). 2024 Oct;87(4):505-513. doi: 10.4046/trd.2024.0003. Epub 2024 Apr 30.
Clinical data for bacterial coinfection of the lower respiratory tract in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) are scarce. This study aims to assess the prevalence of bacterial coinfection and clinical features in NTM-PD patients.
This retrospective study screened 248 patients with NTM-PD who underwent bronchoscopy between July 2020 and July 2022, from whom newly diagnosed NTM-PD patients were analyzed. Bacterial culture using bronchial washing fluid was performed at the time of NTM-PD diagnosis.
In the 180 patients (median age 65 years; 68% female), Mycobacterium avium complex (86%) was the most frequent NTM isolated. Bacterial coinfections were detected in 80 (44%) patients. Among them, the most common bacterium was Klebsiella pneumoniae (n=25/80, 31.3%), followed by Pseudomonas aeruginosa (n=20/80, 25%) and Staphylococcus aureus (n=20/80, 25%). Compared with NTM-PD patients without bacterial coinfections, patients with bacterial coinfections showed more frequent extensive lung involvement (33% vs. 1%, p<0.001). Additionally, compared with NTM-PD patients without P. aeruginosa infection, those with P. aeruginosa infection were older (74 years vs. 64 years, p=0.001), had more frequent respiratory symptoms (cough/excessive mucus production 70% vs. 38%, p=0.008; dyspnea 30% vs. 13%, p=0.047), and had extensive lung involvement (60% vs. 9%, p<0.001).
Less than half of patients with newly diagnosed NTM-PD had bacterial coinfections, linked to extensive lung involvement. Specifically, P. aeruginosa coinfection was significantly associated with older age, more frequent respiratory symptoms, and extensive lung involvement.
非结核分枝杆菌肺病（NTM-PD）患者下呼吸道细菌合并感染的临床数据匮乏。本研究旨在评估NTM-PD患者细菌合并感染的患病率及临床特征。
这项回顾性研究筛选了2020年7月至2022年7月期间接受支气管镜检查的248例NTM-PD患者，并对新诊断的NTM-PD患者进行分析。在NTM-PD诊断时，使用支气管冲洗液进行细菌培养。
在180例患者（中位年龄65岁；68%为女性）中，鸟分枝杆菌复合群（86%）是最常分离出的非结核分枝杆菌。80例（44%）患者检测到细菌合并感染。其中，最常见的细菌是肺炎克雷伯菌（n=25/80，31.3%），其次是铜绿假单胞菌（n=20/80，25%）和金黄色葡萄球菌（n=20/80，25%）。与无细菌合并感染的NTM-PD患者相比，有细菌合并感染的患者肺部广泛受累更为常见（33%对1%，p<0.001）。此外，与无铜绿假单胞菌感染的NTM-PD患者相比，有铜绿假单胞菌感染的患者年龄更大（74岁对64岁，p=0.001），呼吸道症状更频繁（咳嗽/黏液分泌过多70%对38%，p=0.008；呼吸困难30%对13%，p=0.047），且肺部广泛受累（60%对9%，p<0.001）。
新诊断的NTM-PD患者中不到一半有细菌合并感染，这与肺部广泛受累有关。具体而言，铜绿假单胞菌合并感染与年龄较大、呼吸道症状更频繁以及肺部广泛受累显著相关。
