Suzuki Hitoshi, Ito Daisuke, Shinoda Mari, Shomura Shin, Inoue Kentaro, Shimamoto Akira
Department of Thoracic Surgery, Mie Prefectural General Medical Center, Yokkaichi, JPN.
Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Mie University, Tsu, JPN.
Cureus. 2025 Apr 15;17(4):e82337. doi: 10.7759/cureus.82337. eCollection 2025 Apr.
Introduction The incidence of pulmonary nontuberculous mycobacterial (NTM) infections has increased in recent decades. But NTM empyema is still a rare disease. The purpose of this study was to clarify the clinical characteristics and outcomes of NTM empyema. Methods The medical records of 484 patients with pulmonary NTM disease (NTM empyema 15, NTM disease without empyema 469) and 367 patients with acute empyema (NTM empyema 15, other empyema 352) were retrospectively reviewed and investigated patients with empyema with other causes as well as patients with NTM empyema from January 2012 to December 2024 in our hospital. NTM empyema was defined as a positive NTM culture of pleural effusion samples and had purulent pleural effusion. Results Among patients with pulmonary NTM and patients with acute empyema in our study, 15 had NTM empyema (3.1%, 4.1%). Age (median 78 vs. 68, p=0.0072), male (60.0% vs. 32.4%, p=0.0256), Charlson Comorbidity Index (CCI, median 6 vs. 4, p=0.0007) and fibrocavitary form patients (60.0% vs. 21.5%, p=0.0005) were higher in the NTM empyema than in the NTM disease without empyema. Although the same long-term follow-up as NTM disease without empyema was performed, the long-term prognosis of NTM empyema was poorer than that of NTM disease without empyema. Ten out of 15 patients with NTM empyema and 52 out of 352 patients with other empyema patients were complicated with pneumothorax. Compared to patients with other empyema, patients with NTM empyema had higher incidences of pneumothorax (66.7% vs. 14.8%, p=0.00001). Surgical treatments were performed for 11 patients of 15 NTM empyema - two patients died (18.2%) - and were more frequently performed for other empyema. There were significant differences between the mortality rate for fistulous patients with NTM empyema and those for fistulous patients with other empyema (40.0% vs. 11.5%, p=0.0250). All patients with NTM empyema who died had pneumothorax. No fistulous patient with NTM empyema was cured without surgical treatment. Conclusions NTM empyema patients had higher rates of fibrocavitary form, were male, and had higher CCI, and the long-term prognosis of NTM empyema was poorer than that of NTM disease without empyema. In addition, this study revealed that NTM empyema has a poor prognosis and is difficult to treat without chest tube drainage or surgical treatment. Early surgical intervention should be considered for patients with fistulous NTM empyema.
引言 近几十年来，肺部非结核分枝杆菌（NTM）感染的发病率有所上升。但NTM脓胸仍然是一种罕见疾病。本研究的目的是阐明NTM脓胸的临床特征和转归。方法 回顾性分析2012年1月至2024年12月我院484例肺部NTM病患者（NTM脓胸15例，非NTM脓胸的NTM病469例）和367例急性脓胸患者（NTM脓胸15例，其他脓胸352例）的病历，并对其他原因引起的脓胸患者以及NTM脓胸患者进行调查。NTM脓胸定义为胸腔积液样本NTM培养阳性且有脓性胸腔积液。结果 在本研究的肺部NTM病患者和急性脓胸患者中，有15例为NTM脓胸（3.1%，4.1%）。NTM脓胸患者的年龄（中位数78岁 vs. 68岁，p = 0.0072）、男性比例（60.0% vs. 32.4%，p = 0.0256）、Charlson合并症指数（CCI，中位数6 vs. 4，p = 0.0007）以及纤维空洞型患者比例（60.0% vs. 21.5%，p = 0.0005）均高于非NTM脓胸的NTM病患者。尽管对非NTM脓胸的NTM病患者进行了相同的长期随访，但NTM脓胸的长期预后比非NTM脓胸的NTM病患者差。15例NTM脓胸患者中有10例、352例其他脓胸患者中有52例并发气胸。与其他脓胸患者相比，NTM脓胸患者气胸发生率更高（66.7% vs. 14.8%，p = 0.00001）。15例NTM脓胸患者中有11例接受了手术治疗，2例死亡（18.2%），其他脓胸患者接受手术治疗更为频繁。NTM脓胸瘘管患者的死亡率与其他脓胸瘘管患者的死亡率之间存在显著差异（40.0% vs. 11.5%，p = 0.0250）。所有死亡的NTM脓胸患者均有气胸。未经手术治疗，NTM脓胸瘘管患者无一治愈。结论 NTM脓胸患者纤维空洞型比例更高、男性居多且CCI更高，NTM脓胸的长期预后比非NTM脓胸的NTM病患者差。此外，本研究表明NTM脓胸预后不良，若无胸腔闭式引流或手术治疗则难以治愈。对于NTM脓胸瘘管患者应考虑早期手术干预。
