Bai Alice, Dandapani Hari, Dosanjh Amrita
The Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
The Warren Alpert Medical School, Brown University, Providence, RI, USA.
Pediatric Health Med Ther. 2025 Jul 16;16:171-182. doi: 10.2147/PHMT.S513904. eCollection 2025.
The prevalence of pulmonary nontuberculous mycobacteria (NTM) infection and disease is increasing globally. Pediatric studies on treatment of pulmonary NTM disease in immunocompetent infants are limited, and adult guidelines lack details regarding age-specific management strategies. This systematic review analyzes pharmaceutical, procedural, and supportive management strategies for pulmonary NTM infections in immunocompetent infants based on published case reports and series.
A systematic review of PubMed for case reports on pulmonary NTM infections in immunocompetent infants (≤24 months) until December 2023 was conducted. Demographic information, therapeutic interventions, procedural details, and patient outcomes were extracted to Covidence. Data on therapeutic strategies were summarized descriptively.
Twenty-six case reports describing 33 infants with pulmonary NTM were identified. Study demographics included: 55% female, median age at diagnosis was 12 months, and complex (58%) was the most common NTM strain. Most patients (94%) received antibiotic therapy, with a median treatment duration of 30 weeks. Common regimens included combined ethambutol with rifampin (n=9) or clarithromycin (n=6), and clarithromycin with amikacin (n=6). Most patients started on therapy for tuberculosis before switching treatment courses after NTM diagnosis. Common antibiotic classes after NTM diagnosis were macrolides, antituberculous, and aminoglycosides. Non-pharmaceutical therapies included 79% undergoing diagnostic bronchoscopy, 39% receiving tissue debulking, 33% undergoing surgical biopsy for diagnostic confirmation, and 12% requiring lung resection. Two patients underwent surgical interventions without antibiotics. Supportive therapies included non-invasive supplemental oxygen (12%) and mechanical ventilation (6%), with three patients admitted to intensive care units. Overall survival rate was 94%.
This study reports diverse therapeutic approaches to management of immunocompetent infants with diagnosed pulmonary NTM disease, which utilized varying antibiotics and procedural interventions. Although few patient deaths were reported, these results suggest a need for additional prospective studies to compare efficacy of treatment regimens and establish tailored pediatric guidelines for disease management.
全球范围内，肺部非结核分枝杆菌（NTM）感染和疾病的患病率正在上升。关于免疫功能正常婴儿肺部NTM疾病治疗的儿科研究有限，而成人指南缺乏针对特定年龄管理策略的详细信息。本系统评价基于已发表的病例报告和系列研究，分析免疫功能正常婴儿肺部NTM感染的药物、程序和支持性管理策略。
对PubMed进行系统检索，以查找截至2023年12月关于免疫功能正常婴儿（≤24个月）肺部NTM感染的病例报告。将人口统计学信息、治疗干预措施、程序细节和患者结局提取到Covidence中。对治疗策略的数据进行描述性总结。
共识别出26篇描述33例肺部NTM婴儿的病例报告。研究的人口统计学特征包括：55%为女性，诊断时的中位年龄为12个月，复杂NTM菌株（58%）是最常见的NTM菌株。大多数患者（94%）接受了抗生素治疗，中位治疗持续时间为30周。常见方案包括乙胺丁醇联合利福平（n = 9）或克拉霉素（n = 6），以及克拉霉素联合阿米卡星（n = 6）。大多数患者在NTM诊断前开始接受抗结核治疗，之后更换治疗方案。NTM诊断后的常见抗生素类别为大环内酯类、抗结核药和氨基糖苷类。非药物治疗包括79%的患者接受诊断性支气管镜检查，39%的患者接受组织减容，33%的患者接受手术活检以确诊，12%的患者需要肺切除术。两名患者在未使用抗生素的情况下接受了手术干预。支持性治疗包括无创补充氧气（12%）和机械通气（6%），三名患者入住重症监护病房。总体生存率为94%。
本研究报告了多种治疗免疫功能正常的确诊肺部NTM疾病婴儿的方法，这些方法使用了不同的抗生素和程序干预措施。尽管报告的患者死亡病例很少，但这些结果表明需要进行更多的前瞻性研究，以比较治疗方案的疗效，并制定针对该疾病管理的量身定制的儿科指南。
