Abstract
Objectives The purpose of this study was to clarify the clinical characteristics and report the efficacy of our therapeutic strategy for treating nontuberculous mycobacterial empyema (NTM empyema).
Methods The medical records of 302 patients with pulmonary nontuberculous mycobacterial (NTM) disease were retrospectively reviewed, and 364 patients with acute empyema were prospectively reviewed to select patients complicated by NTM empyema from September 2014 to December 2022 in our hospital. NTM empyema was defined as a positive NTM culture of pleural effusion samples.
Results
Among 304 patients with pulmonary NTM, 13 had NTM empyema (4.3%). The mean age was 78 years, the mean performance status (PS) was 3, and 9 patients (69.2%) had pneumothorax. Age, male sex, comorbidities, fibrocavitary forms, pneumothorax, and lung cavitation were more common in patients with NTM empyema than in patients without NTM disease. Age, PS, comorbidity rate, pneumothorax incidence, and mortality rate were higher in the NTM empyema group than in the non-NTM empyema group. Similarly, the percentage of patients who were cured of pneumothorax without surgical intervention was significantly lower in the NTM empyema group (15.4%) than in the non-NTM empyema group (78.0%).
Conclusions
This study revealed that NTM empyema has a poor prognosis and is difficult to treat with medication alone. Fistulous NTM empyema should also be added to the indications for surgical intervention. Early surgical intervention should be considered for selected patients with NTM empyema.