Cargando…
Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States
Nontuberculous mycobacterial (NTM) infections present a treatment challenge for clinicians and patients. There are limited data about current susceptibility patterns and treatment outcomes in U.S. adults. This was a 10-year, single-center, retrospective, observational cohort study of adults with a p...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9774830/ https://www.ncbi.nlm.nih.gov/pubmed/36551377 http://dx.doi.org/10.3390/antibiotics11121720 |
_version_ | 1784855504880664576 |
---|---|
author | Tsai, Yuwei Vivian Derrick, Caroline Yunusa, Ismaeel Weissman, Sharon Al-Hasan, Majdi N. Justo, Julie Ann Bookstaver, Paul Brandon |
author_facet | Tsai, Yuwei Vivian Derrick, Caroline Yunusa, Ismaeel Weissman, Sharon Al-Hasan, Majdi N. Justo, Julie Ann Bookstaver, Paul Brandon |
author_sort | Tsai, Yuwei Vivian |
collection | PubMed |
description | Nontuberculous mycobacterial (NTM) infections present a treatment challenge for clinicians and patients. There are limited data about current susceptibility patterns and treatment outcomes in U.S. adults. This was a 10-year, single-center, retrospective, observational cohort study of adults with a positive NTM culture and clinical suspicion of infection between 1 January 2010 and 30 June 2020. The primary objective was to identify predictors for favorable treatment outcomes. Key secondary objectives were characterization of NTM epidemiology, susceptibility profiles, and safety and tolerability of treatment, including the proportion of subjects with an antimicrobial change and the reasons for the change. Of 250 subjects diagnosed with NTM infection, the most prevalent NTM isolates were Mycobacterium avium intracellulare complex (66.8%) followed by Mycobacterium abscessus (17.6%). Antimicrobial susceptibility data were available for 52.4% of the cohort (45.8% slow growers; 54.2% rapid growers). Only 88 (35%) subjects received treatment with evaluable clinical outcomes. The proportion of subjects with a favorable outcome was 61.4%. More subjects in the unfavorable outcome group experienced a change in antimicrobial therapy (73.5% vs. 51.9%, p = 0.043). The most common reason for antimicrobial change was adverse drug events (n = 36, 67.9%). In the regression model, private insurance was associated with a favorable outcome, whereas having multiple antimicrobial changes was associated with an unfavorable outcome. The complexity of NTM treatment and high incidence of medication-related issues suggest the necessity of interdisciplinary collaboration to improve overall treatment outcomes in NTM infections. |
format | Online Article Text |
id | pubmed-9774830 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-97748302022-12-23 Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States Tsai, Yuwei Vivian Derrick, Caroline Yunusa, Ismaeel Weissman, Sharon Al-Hasan, Majdi N. Justo, Julie Ann Bookstaver, Paul Brandon Antibiotics (Basel) Article Nontuberculous mycobacterial (NTM) infections present a treatment challenge for clinicians and patients. There are limited data about current susceptibility patterns and treatment outcomes in U.S. adults. This was a 10-year, single-center, retrospective, observational cohort study of adults with a positive NTM culture and clinical suspicion of infection between 1 January 2010 and 30 June 2020. The primary objective was to identify predictors for favorable treatment outcomes. Key secondary objectives were characterization of NTM epidemiology, susceptibility profiles, and safety and tolerability of treatment, including the proportion of subjects with an antimicrobial change and the reasons for the change. Of 250 subjects diagnosed with NTM infection, the most prevalent NTM isolates were Mycobacterium avium intracellulare complex (66.8%) followed by Mycobacterium abscessus (17.6%). Antimicrobial susceptibility data were available for 52.4% of the cohort (45.8% slow growers; 54.2% rapid growers). Only 88 (35%) subjects received treatment with evaluable clinical outcomes. The proportion of subjects with a favorable outcome was 61.4%. More subjects in the unfavorable outcome group experienced a change in antimicrobial therapy (73.5% vs. 51.9%, p = 0.043). The most common reason for antimicrobial change was adverse drug events (n = 36, 67.9%). In the regression model, private insurance was associated with a favorable outcome, whereas having multiple antimicrobial changes was associated with an unfavorable outcome. The complexity of NTM treatment and high incidence of medication-related issues suggest the necessity of interdisciplinary collaboration to improve overall treatment outcomes in NTM infections. MDPI 2022-11-29 /pmc/articles/PMC9774830/ /pubmed/36551377 http://dx.doi.org/10.3390/antibiotics11121720 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Tsai, Yuwei Vivian Derrick, Caroline Yunusa, Ismaeel Weissman, Sharon Al-Hasan, Majdi N. Justo, Julie Ann Bookstaver, Paul Brandon Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States |
title | Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States |
title_full | Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States |
title_fullStr | Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States |
title_full_unstemmed | Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States |
title_short | Epidemiology, Outcomes and Tolerability of Protracted Treatment of Nontuberculous Mycobacterial Infections at a Community Teaching Hospital in the Southeastern United States |
title_sort | epidemiology, outcomes and tolerability of protracted treatment of nontuberculous mycobacterial infections at a community teaching hospital in the southeastern united states |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9774830/ https://www.ncbi.nlm.nih.gov/pubmed/36551377 http://dx.doi.org/10.3390/antibiotics11121720 |
work_keys_str_mv | AT tsaiyuweivivian epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates AT derrickcaroline epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates AT yunusaismaeel epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates AT weissmansharon epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates AT alhasanmajdin epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates AT justojulieann epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates AT bookstaverpaulbrandon epidemiologyoutcomesandtolerabilityofprotractedtreatmentofnontuberculousmycobacterialinfectionsatacommunityteachinghospitalinthesoutheasternunitedstates |