Meena Durga Shankar, Kumar Deepak, Bohra Gopal Krishana, Midha Naresh, Garg Mahendra Kumar
Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Open Forum Infect Dis. 2024 Nov 19;11(12):ofae688. doi: 10.1093/ofid/ofae688. eCollection 2024 Dec.
Infective endocarditis (IE) due to nontuberculous mycobacteria (NTM) is a rare infection, and several outbreaks have been reported in the last 2 decades. However, the clinical spectrum is still poorly understood. This systematic review aimed to evaluate the clinical characteristics and outcomes in NTM IE.
We searched the major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords to December 2023. We included studies based on predefined diagnostic criteria, and relevant data were collected on clinical presentation and treatment outcomes. The study was registered with PROSPERO (CRD42023492577).
A total of 97 studies were reviewed, encompassing 167 patients with NTM IE. The earliest cases were reported in 1975, involving and . was the most prevalent species (38.9%), though rapidly growing NTM (RGM) were more common than slow-growing NTM (SGM; 59.3% vs 40.7%). Disseminated NTM infection occurred in 84% of cases, with bone marrow infiltration and osteomyelitis as frequent manifestations. Prosthetic valves were the main risk factor, present in 63.5% of cases. In native valve IE, nearly all cases (n = 27, 96%) were attributed to RGM. The overall mortality rate was 44.9%, with conservative management without surgery associated with poorer outcomes (66.7% vs 30.6%). Mortality was comparable between SGM and RGM IE, although relapses were more common in SGM IE (17.6% vs 1.9%).
This review highlights the changing epidemiology of NTM IE with the emergence of RGM IE. Disseminated infections in the setting of prosthetic valves warrant NTM evaluation. The high mortality rate necessitates the role of early surgery.
非结核分枝杆菌（NTM）引起的感染性心内膜炎（IE）是一种罕见的感染，在过去20年中有多起暴发报道。然而，其临床谱仍未得到充分了解。本系统评价旨在评估NTM IE的临床特征和结局。
我们使用适当的关键词检索了主要电子数据库（PubMed、Scopus和谷歌学术）至2023年12月。我们纳入基于预定义诊断标准的研究，并收集有关临床表现和治疗结局的相关数据。该研究已在国际前瞻性系统评价注册库（PROSPERO）注册（CRD42023492577）。
共审查了97项研究，涵盖167例NTM IE患者。最早的病例报告于1975年，涉及[此处信息缺失]。[此处信息缺失]是最常见的菌种（38.9%），尽管快速生长的NTM（RGM）比缓慢生长的NTM更常见（59.3%对40.7%）。84%的病例发生播散性NTM感染，骨髓浸润和骨髓炎是常见表现。人工瓣膜是主要危险因素，63.5%的病例存在。在天然瓣膜IE中，几乎所有病例（n = 27，96%）归因于RGM。总体死亡率为44.9%，保守治疗而非手术治疗的结局较差（66.7%对30.6%）。SGM IE和RGM IE的死亡率相当，尽管SGM IE的复发更常见（17.6%对1.9%）。
本综述强调了随着RGM IE的出现，NTM IE的流行病学变化。人工瓣膜情况下的播散性感染需要进行NTM评估。高死亡率凸显了早期手术的作用。
