한빛사 논문
Nakwon Kwak1, Margareth Pretti Dalcolmo2, Charles L. Daley3, Geoffrey Eather4, Regina Gayoso2, Naoki Hasegawa5, Byung Woo Jhun6, Won-Jung Koh6, Ho Namkoong7, Jimyung Park1, Rachel Thomson8, Jakko van Ingen9, Sanne M.H. Zweijpfenning10 and Jae-Joon Yim1,*
1 Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
2 Centro de Referencia Helio Fraga, Escola Nacional de Saúde Pública, FIOCRUZ, Rio de Janeiro, Brazil
3 Division of Mycobacterial and Respiratory Infections, Dept of Medicine, National Jewish Health, Denver, CO, USA
4 Metro South Clinical Tuberculosis Service and Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
5 Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan
6 Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
7 Division of Pulmonary Medicine, Dept of Medicine, Keio University School of Medicine, Tokyo, Japan
8 Gallipoli Medical Research Institute, University of Queensland, Brisbane, Australia
9 Dept of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
10 Dept of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
*Address Correspondence and Reprint Requests to Jae-Joon Yim, Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea.
Abstract
Treatment of Mycobacterium abscessus pulmonary disease (MAB-PD), caused by M. abscessus subsp. abscessus, M. abscessus subsp. massiliense or M. abscessus subsp. bolletii, is challenging.
We conducted an individual patient data meta-analysis based on studies reporting treatment outcomes for MAB-PD to clarify treatment outcomes for MAB-PD and the impact of each drug on treatment outcomes. Treatment success was defined as culture conversion for ≥12 months while on treatment or sustained culture conversion without relapse until the end of treatment.
Among 14 eligible studies, datasets from eight studies were provided and a total of 303 patients with MAB-PD were included in the analysis. The treatment success rate across all patients with MAB-PD was 45.6%. The specific treatment success rates were 33.0% for M. abscessus subsp. abscessus and 56.7% for M. abscessus subsp. massiliense. For MAB-PD overall, the use of imipenem was associated with treatment success (adjusted odds ratio (aOR) 2.65, 95% CI 1.36–5.10). For patients with M. abscessus subsp. abscessus, the use of azithromycin (aOR 3.29, 95% CI 1.26–8.62), parenteral amikacin (aOR 1.44, 95% CI 1.05–1.99) or imipenem (aOR 7.96, 95% CI 1.52–41.6) was related to treatment success. For patients with M. abscessus subsp. massiliense, the choice among these drugs was not associated with treatment outcomes.
Treatment outcomes for MAB-PD are unsatisfactory. The use of azithromycin, amikacin or imipenem was associated with better outcomes for patients with M. abscessus subsp. abscessus.
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