Recovery of nontuberculous mycobacterium (NTM) from respiratory samples of patients with bronchiectasis presents a conundrum because therapy is prolonged and may not be well tolerated. Few studies have evaluated the clinical impact of NTM colonization in patients with bronchiectasis.
We established a database of patients with radiographic evidence of bronchiectasis, and identified 33 patients with respiratory samples that grew NTM, 13 met American Thoracic Society (ATS) microbiologic criteria for NTM infection. Our review was limited to the previous 5 years and excluded patients with cystic fibrosis. We compared these patients to 80 age-matched patients with bronchiectasis but without NTM. Nutritional status, pulmonary function, and health care utilization was assessed.
Overall, patients with bronchiectasis were comprised of 57% females and 43% males. Mean age was 55 years (SD+/−11.5). There were 60% whites, 38% blacks, 1% Asian, and 1% Hispanic. Those with NTM positive cultures were more likely to be female (likelihood ratio 5.08, p = 0.02) and white (likelihood ratio 7.81, p = 0.05). The two groups were similar with respect to nutritional status and pulmonary function, even when accounting for the greater number of females in the NTM-positive group. Number of hospitalizations and number of inpatient days were similar between the two groups. There were a high number of outpatient visits in this population overall, and the NTM-negative group had significantly more clinic visits than did those who were NTM-positive. Similar conclusions were reached when we considered only patients who met ATS criteria for NTM infection.
The presence of NTM in cultures of respiratory specimens from bronchiectasis patients does not appear to be associated with adverse outcomes, specifically nutritional status, pulmonary function, or healthcare utilization.
Treatment decisions for patients with bronchiectasis and NTM remain problematic. These data suggest that the mere presence of NTM in respiratory cultures does not warrant initiation of therapy. Further studies evaluating the natural history of NTM on patient symptoms and quality of life are needed.
Sandra Gilley, No Financial Disclosure Information; No Product/Research Disclosure Information