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Volume 48, Number 4, August 2015

Risk factors for microbiologic failure among Taiwanese adults with Mycobacterium abscessus complex pulmonary disease 


Yu-Jung Tung, Sheikh Omer Bittaye, Jong-Rung Tsai, Chun-Yu Lin, Chung-Hao Huang, Tun-Chieh Chen, Wei-Ru Lin, Ko Chang, Chung-Chih Lai, Po-Liang Lu, Yen-Hsu Chen


Received: April 29, 2014    Revised: August 5, 2014    Accepted: August 7, 2014   

 

Corresponding author:

Yen-Hsu Chen
Corresponding author. Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Number 100, Tzyou 1st Road, Kaohsiung City, Taiwan. 



 

Background and purpose: 

The Mycobacterium abscessus complex is a common cause of pulmonary nontuberculous mycobacteria infections in Taiwan. We examined the risk factors associated with treatment outcome in Taiwanese adults with pulmonary disease caused by the M. abscessus complex. 



 

Methods:

We retrospectively reviewed the records of all patients from a southern Taiwan medical center from 2006 to 2012 who had respiratory specimens identified as M. abscessus complex and met the American Thoracic Society criteria for pulmonary disease. 



 

Results:

Of the 106 included patients, females (58.5%) and nonsmokers (79.2%) predominated. The mean age of patients was 64.8 years. Sixty-three patients (59.4%) had pre-existing lung disease. Previous mycobacterial pulmonary disease (34.9%) was the most common underlying disorder. Chest radiography indicated that bronchiectasis was common (47.2%) and that cavitations were less common (14.2%). Fifty-six patients received antibiotic treatment. Clinicians were more likely to prescribe antibiotics if the initial sputum acid-fast staining was positive (p < 0.001). Treatment outcome was analyzed in 26 patients who were treated for more than 3 months; three of these patients (11.5%) had clinical failure and 18 (69.2%) experienced sputum conversion. Patients with cavitary lesions were more likely to experience microbiologic failure (p = 0.02). Nine patients had positive cultures after antibiotic treatment for > 1 year. Previous mycobacterial pulmonary disease (p = 0.011) and cavitary lesion (p = 0.034) are risk factors for persistence of M. abscessus complex. 



 

Conclusion:

With antimicrobial therapy, previous mycobacterial disease, and cavitary lesion are associated with microbiologic failure in Taiwanese adults with M. abscessus complex pulmonary disease. 



 

Key words:

cavity, Mycobacterium abscessus complex, nontuberculous mycobacterium, outcome, tuberculosis