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Original Research |

Microbiological and clinical outcomes of treating non-MAC NTM pulmonary disease: A systematic review and meta-analysis

R. Diel; F.C. Ringshausen; E. Richter; L. Welker; J. Schmitz; A. Nienhaus
Author and Funding Information

Potential conflicts of interest: R.D. has received fees for lectures and/or consultancy from Insmed and Riemser. F.R. reports grants, personal fees and other from Bayer HealthCare, Grifols Germany, Insmed and InfectoPharm. All other authors have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

1Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany. Member of the German Center for Lung Research (ARCN)

2LungClinic Grosshansdorf, Germany. Airway Research Center North (ARCN), German Center for Lung Research (DZL)

3Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. Member of the German Center for Lung Research (BREATH)

4MVZ Labor Dr. Limbach, TB Laboratory, Heidelberg, Germany

5Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

6Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany Start, Germany

Address for correspondence: Roland Diel, MD, MPH, Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Niemannsweg 11, 24015 Kiel, Germany.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.166
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Abstract

Background  Pulmonary disease caused by non-tuberculous mycobacteria (NTM) is steadily increasing worldwide.

Methods  A systematic review of Non-Mycobacterium avium complex studies published prior to October 2016 was conducted with respect to microbiological and clinical outcomes of current treatment regimens.

Results  We retrieved 352 citations; these yielded 24 studies eligible for evaluation. Sixteen studies were retrospective chart reviews, 3 were prospective and only 5 randomized. The weighted average proportion of sputum culture conversions (SCC) after subtracting post-treatment relapses for patients with Mycobacterium abscessus was 41.2% (95% CI; 28.6%-54.5%), but 69.8% (95% CI; 41.0%-91.9%) with subspecies M. massiliense in macrolide-containing regimens, 80.2% (95% CI; 58.4%-95.2%) in patients with M. kansasii (MK), 32.0% (95% CI; 16.5%-49.8%) with M. xenopi (MX) and 54.4% (95% CI; 34.7%-73.4%) with M. malmoense. SCC in the total of 55 patients with lung resection and MX or M. abscessus was high at 75.9%.The risk of bias was low in 4 of 5 randomized studies. However, heterogeneous use of outcome parameters (8 definitions of “relapse,” 8 of “treatment success” and 4 of “cure”) hampered comparison of non-randomized studies as well as possible bias by a posteriori exclusion (13.3%) and uncompleted treatment of participants (25.3%).

Conclusion  As sustained microbiological response without surgery is unsatisfactory in treating M. abscessus, MX and M. malmoense, functional and quality of life aspects should be given more emphasis in the individual evaluation of treatment outcome. Further properly planned studies with sufficient power are needed as well as new drugs and/or better-tolerated application of current antibiotics.


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