Chung Chiwook
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
Ewha Med J. 2025 Apr;48(2):e25. doi: 10.12771/emj.2025.00080. Epub 2025 Mar 26.
The complex (MAC), comprising and , constitutes the predominant cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea, followed by the complex. Its global prevalence is increasing, as shown by a marked rise in Korea from 11.4 to 56.7 per 100,000 individuals between 2010 and 2021, surpassing the incidence of tuberculosis. Among the older adult population (aged ≥65 years), the prevalence escalated from 41.9 to 163.1 per 100,000, accounting for 47.6% of cases by 2021. Treatment should be individualized based on prognostic indicators, including cavitary disease, low body mass index, and positive sputum smears for acid-fast bacilli. Current therapeutic guidelines recommend a 3-drug regimen-consisting of a macrolide, rifampin, and ethambutol-administered for a minimum of 12 months following culture conversion. Nevertheless, treatment success rates are only roughly 60%, and over 30% of patients experience recurrence. This is often attributable to reinfection rather than relapse. Antimicrobial susceptibility testing for clarithromycin and amikacin is essential, as resistance significantly worsens prognosis. Ethambutol plays a crucial role in preventing the development of macrolide resistance, whereas the inclusion of rifampin remains a subject of ongoing debate. Emerging therapeutic strategies suggest daily dosing for milder cases, increased azithromycin dosing, and the substitution of rifampin with clofazimine in severe presentations. Surgical resection achieves a notable sputum conversion rate of approximately 93% in eligible candidates. For refractory MAC-PD, adjunctive therapy with amikacin is advised, coupled with strategies to reduce environmental exposure. Despite advancements in therapeutic approaches, patient outcomes remain suboptimal, highlighting the urgent need for novel interventions.
由[具体菌种1]和[具体菌种2]组成的[某种复合菌]是韩国非结核分枝杆菌肺病（NTM-PD）的主要病因，其次是[另一种复合菌]。其全球患病率正在上升，韩国从2010年至2021年每10万人中的患病率从11.4显著升至56.7，超过了结核病的发病率。在老年人群（≥65岁）中，患病率从每10万人41.9升至163.1，到2021年占病例的47.6%。治疗应根据预后指标个体化，包括空洞性疾病、低体重指数和痰涂片抗酸杆菌阳性。当前治疗指南推荐一种三联药物方案——由大环内酯类、利福平和乙胺丁醇组成——在培养转阴后至少使用12个月。然而，治疗成功率仅约为60%，超过30%的患者会复发。这通常归因于再次感染而非复发。对克拉霉素和阿米卡星进行药敏试验至关重要，因为耐药会显著恶化预后。乙胺丁醇在预防大环内酯类耐药的发生中起关键作用，而是否纳入利福平仍存在争议。新出现的治疗策略建议对病情较轻的病例每日给药，增加阿奇霉素剂量，并在重症病例中用氯法齐明替代利福平。手术切除在符合条件的患者中可实现约93%的显著痰菌转阴率。对于难治性MAC-PD，建议联合阿米卡星进行辅助治疗，并采取减少环境暴露的策略。尽管治疗方法有所进步，但患者预后仍然不理想，凸显了对新干预措施的迫切需求。
