Management of patients with pulmonary mycobacteriosis in France: a multicenter retrospective cohort study

Author:

Bemer Pascale,Peuchant Olivia,Guet-Revillet Hélène,Bador Julien,Balavoine Charlotte,Basille Damien,Beltramo Guillaume,Blanc François-Xavier,Blanchard Elodie,Boulanger Sarah,Bourgoin Anne,Boutoille David,Cambau Emmanuelle,Canis Frédérique,Caparros Didier,Carricajo Anne,Carrière Christian,Couetdic Gérard,Couturaud Francis,Dalphin Jean-Charles,Degot Tristan,Desquiens Marion,Devouassoux Gilles,Duez Jean-Marie,Dumitrescu Oana,Dupuy-Grasset Magali,Gaudart Alice,Georges Marjolaine,Godet Cendrine,Godreuil Sylvain,Guillouzouic Aurélie,Hamdad-Daoudi Farida,Héry-Arnaud Geneviève,Koebel Christelle,Lagrange Aurore,Lanotte Philippe,Marchand-Adam Sylvain,Mougari Faïza,Murris Marlène,Patry Isabelle,Pérouse de Montclos Michèle,Raskine Laurent,Risso Karine,Segonds Christine,Sicard Dominique,Terru Dominique,Vachée Anne,Vergnon Jean-Michel,Martin Christian,Schramm Frédéric,Andrejak ClaireORCID

Abstract

Abstract Background Recent studies report very low adherence of practitioners to ATS/IDSA recommendations for the treatment of nontuberculous mycobacteria pulmonary disease (NTM-PD), as well as a great variability of practices. Type of management could impact prognosis. Methods To evaluate management and prognosis of patients with NTM-PD cases with respect to ATS recommendations, we conducted a multicenter retrospective cohort study (18 sentinel sites distributed throughout France), over a period of six years. We collected clinical, radiological, microbiological characteristics, management and outcome of the patients (especially death or not). Results 477 patients with NTM-PD were included. Respiratory comorbidities were found in 68% of cases, tuberculosis sequelae in 31.4% of patients, and immunosuppression in 16.8% of cases. The three most common NTM species were Mycobacterium avium complex (60%), M. xenopi (20%) and M. kansasii (5.7%). Smear-positive was found in one third of NTM-PD. Nodulobronchiectatic forms were observed in 54.3% of cases, and cavitary forms in 19.1% of patients. Sixty-three percent of patients were treated, 72.4% of patients with smear-positive samples, and 57.5% of patients with smear-negative samples. Treatment was in adequacy with ATS guidelines in 73.5%. The 2-year mortality was 14.4%. In the Cox regression, treatment (HR = 0.51), age (HR = 1.02), and M. abscessus (3.19) appeared as the 3 significant independent prognostic factors. Conclusion These findings highlight the adequacy between French practices and the ATS/IDSA guidelines. Treatment was associated with a better survival.

Publisher

Springer Science and Business Media LLC

Subject

Pulmonary and Respiratory Medicine

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