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Nontuberculous mycobacteria pulmonary infection in medical intensive care unit: the incidence, patient characteristics, and clinical significanceOpen access

Chin-Chung Shu| Chih-Hsin Lee| Jann-Yuan Wang| Jih-Shuin Jerng| Chong-Jen Yu| Po-Ren Hsueh| Li-Na Lee| Pan-Chyr Yang
Original
Volume 34, Issue 12 / December , 2008

Pages 2194 - 2201

Abstract

Background

The clinical significance of nontuberculous mycobacteria (NTM) pulmonary infection in medical intensive care unit (ICU) is still unclear.

Materials and methods

We conducted a retrospective study in the medical ICUs of a medical center in Taiwan from January 1999 to June 2007. Patients with NTM isolated from respiratory specimens within 1 month before or during the ICU course were identified. Those who fulfilled the diagnostic criteria of NTM pulmonary infection were identified and compared with patients with NTM colonization and control subjects who were culture-negative for mycobacteria.

Results

Among the 5,378 patients admitted to medical ICUs, 2,866 (53.3%) had received mycobacterial culture for respiratory specimens. NTM were isolated from 169 (5.8%) patients. Of them, 47 (27.8%) were considered NTM pulmonary infection. M. avium complex and M. abscessus were the most common pathogens. Within 100 days after ICU admission, significantly more patients with NTM infection died than those with NTM colonization and control subjects (47 vs. 8 vs. 14%, < 0.001). Twenty-one (49%) patients with NTM pulmonary infection received anti-NTM treatment, with four experiencing adverse effects. Although statistically insignificant, anti-NTM treatment was associated with prolonged survival for those who died in the ICU and shorter ICU stay for those who survived the ICU course.

Conclusion

Our findings suggest that NTM pulmonary infection seems to associate with higher mortality in medical ICUs. Anti-NTM treatment is probably associated with a better outcome. Therefore, keeping a high suspicion when NTM is isolated and using careful consideration when starting anti-NTM treatment should be emphasized.

Keywords

References

  1. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ Jr, Winthrop K (2007) An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 175:367–416
    • View reference on PubMed
    • View reference on publisher's website
  2. Martin-Casabona N, Bahrmand AR, Bennedsen J, Thomsen VO, Curcio M, Fauville-Dufaux M, Feldman K, Havelkova M, Katila ML, Koksalan K, Pereira MF, Rodrigues F, Pfyffer GE, Portaels F, Urgell JR, Rusch-Gerdes S, Tortoli E, Vincent V, Watt B (2004) Non-tuberculous mycobacteria: patterns of isolation. A multi-country retrospective survey. Int J Tuberc Lung Dis 8:1186–1193
    • View reference on PubMed
  3. Field SK, Cowie RL (2006) Lung disease due to the more common nontuberculous mycobacteria. Chest 129:1653–1672
    • View reference on PubMed
    • View reference on publisher's website
  4. Marras TK, Daley CL (2002) Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med 23:553–567
    • View reference on PubMed
    • View reference on publisher's website
  5. Miguez-Burbano MJ, Flores M, Ashkin D, Rodriguez A, Granada AM, Quintero N, Pitchenik A (2006) Non-tuberculous mycobacteria disease as a cause of hospitalization in HIV-infected subjects. Int J Infect Dis 10:47–55
    • View reference on PubMed
    • View reference on publisher's website
  6. Chetchotisakd P, Kiertiburanakul S, Mootsikapun P, Assanasen S, Chaiwarith R, Anunnatsiri S (2007) Disseminated nontuberculous mycobacterial infection in patients who are not infected with HIV in Thailand. Clin Infect Dis 45:421–427
    • View reference on PubMed
    • View reference on publisher's website
  7. Saritsiri S, Udomsantisook N, Suankratay C (2006) Nontuberculous mycobacterial infections in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 89:2035–2046
    • View reference on PubMed
  8. Pilcher DV, Bailey MJ, Treacher DF, Hamid S, Williams AJ, Davidson AC (2005) Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax 60:187–192
    • View reference on PubMed
    • View reference on publisher's website
  9. Dailloux M, Abalain ML, Laurain C, Lebrun L, Loos-Ayav C, Lozniewski A, Maugein J (2006) Respiratory infections associated with nontuberculous mycobacteria in non-HIV patients. Eur Respir J 28:1211–1215
    • View reference on PubMed
    • View reference on publisher's website
  10. Jann-Yuan Wang P-RH, Chong-Jen Yu, I-Shiow Jan, Li-Na Lee, Pan-Chyr Yang (2007) Cause of Sputum Acid-Fast Smear-Positive: Mycobacterium tuberculosis or nontuberculous mycobacterium. Chest doi:http://www.chestjournal.org/cgi/eletters/129/6/1653
  11. Andrejak C, Lescure FX, Douadi Y, Laurans G, Smail A, Duhaut P, Jounieaux V, Schmit JL (2007) Non-tuberculous mycobacteria pulmonary infection: management and follow-up of 31 infected patients. J Infect 55:34–40
    • View reference on PubMed
    • View reference on publisher's website
  12. Lai CC, Lee LN, Ding LW, Yu CJ, Hsueh PR, Yang PC (2006) Emergence of disseminated infections due to nontuberculous mycobacteria in non-HIV-infected patients, including immunocompetent and immunocompromised patients in a university hospital in Taiwan. J Infect 53:77–84
    • View reference on PubMed
    • View reference on publisher's website
  13. Research Committee, British Thoracic Society (1994) Mycobacterium kansasii pulmonary infection: a prospective study of the results of nine months of treatment with rifampicin and ethambutol. Research Committee, British Thoracic Society. Thorax 49:442–445
  14. Jenkins PA, Campbell IA (2003) Pulmonary disease caused by Mycobacterium xenopi in HIV-negative patients: five year follow-up of patients receiving standardised treatment. Respir Med 97:439–444
    • View reference on PubMed
    • View reference on publisher's website
  15. Koh WJ, Kwon OJ, Jeon K, Kim TS, Lee KS, Park YK, Bai GH (2006) Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest 129:341–348
    • View reference on PubMed
    • View reference on publisher's website
  16. Andreu J, Caceres J, Pallisa E, Martinez-Rodriguez M (2004) Radiological manifestations of pulmonary tuberculosis. Eur J Radiol 51:139–149
    • View reference on PubMed
    • View reference on publisher's website
  17. Menzies D, Joshi R, Pai M (2007) Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 11:593–605
    • View reference on PubMed
  18. Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A (2006) High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 166:2138–2144
    • View reference on PubMed
    • View reference on publisher's website
  19. Wang JY, Hsueh PR, Wang SK, Jan IS, Lee LN, Liaw YS, Yang PC, Luh KT (2007) Disseminated tuberculosis: a 10-year experience in a medical center. Medicine 86:39–46
    • View reference on PubMed
    • View reference on publisher's website
  20. Pfyffer GE, Vicent V, Christina Gutiérrez M, Brown-Elliott BA, Wallace RJ (2007) Myobacterium. In: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Landry ML (eds) Manual of Clinical Microbiology, 9th ed. American Society for Microbiology, Washington, DC, pp 543–600
  21. Wang JY, Hsueh PR, Jan IS, Lee LN, Liaw YS, Yang PC, Luh KT (2006) Empirical treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas. Thorax 61:903–908
    • View reference on PubMed
    • View reference on publisher's website
  22. Society TRCotBT (2003) Pulmonary disease caused by M. malmoense in HIV negative patients: 5-yr follow-up of patients receiving standardised treatment. Eur Respir J 21:478–482
    • View reference on publisher's website
  23. Tanaka E (1998) Clinical features and diagnosis of disease caused by nontuberculous mycobacteria. Nippon Rinsho 56:3195–3198
    • View reference on PubMed
  24. Lawn SD (2005) Acute respiratory failure due to Mycobacterium kansasii infection: immune reconstitution disease in a patient with AIDS. J Infect 51:339–340
    • View reference on PubMed
    • View reference on publisher's website
  25. Miyachi S, Kosuda T, Masai H, Hidaka N, Takizawa H, Hisatomi T (1985) A case of intractable pulmonary infection due to Mycobacterium fortuitum resulting in respiratory failure. Kekkaku 60:277–281
    • View reference on PubMed
  26. Yamada H, Kohyama T, Terashi K, Mori H, Yamaguchi A, Arima N, Tanaka H (1997) Fatal pulmonary infection due to multidrug-resistant Mycobacterium kansasii which developed in an immunocompetent young man. Intern Med 36:298–300
    • View reference on PubMed
    • View reference on publisher's website
  27. Peduzzi P, Concato J, Feinstein AR, Holford TR (1995) Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol 48:1503–1510
    • View reference on PubMed
    • View reference on publisher's website
  28. Miravitlles M, Espinosa C, Fernandez-Laso E, Martos JA, Maldonado JA, Gallego M (1999) Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest 116:40–46
    • View reference on PubMed
    • View reference on publisher's website
  29. Tseng YC, Wang JT, Wu FL, Chen YC, Chie WC, Chang SC (2007) Prognosis of adult patients with bacteremia caused by extensively resistant Acinetobacter baumannii. Diagn Microbiol Infect Dis 59:181–190
    • View reference on PubMed
    • View reference on publisher's website
  30. Griffith DE, Brown-Elliott BA, Langsjoen B, Zhang Y, Pan X, Girard W, Nelson K, Caccitolo J, Alvarez J, Shepherd S, Wilson R, Graviss EA, Wallace RJ Jr (2006) Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 174:928–934
    • View reference on PubMed
    • View reference on publisher's website
  31. Hsu DI, Okamoto MP, Murthy R, Wong-Beringer A (2005) Fluoroquinolone-resistant Pseudomonas aeruginosa: risk factors for acquisition and impact on outcomes. J Antimicrob Chemother 55:535–541
    • View reference on PubMed
    • View reference on publisher's website
  32. Freeman J, Morris A, Blackmore T, Hammer D, Munroe S, McKnight L (2007) Incidence of nontuberculous mycobacterial disease in New Zealand, 2004. N Z Med J 120:U2580
    • View reference on PubMed
  33. O’Brien RJ, Geiter LJ, Snider DE Jr (1987) The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis 135:1007–1014
    • View reference on PubMed
  34. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society (2000) Management of opportunist mycobacterial infections: Joint Tuberculosis Committee Guidelines 1999. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society. Thorax 55:210–218
  35. Tsukamura M, Kita N, Shimoide H, Arakawa H, Kuze A (1988) Studies on the epidemiology of nontuberculous mycobacteriosis in Japan. Am Rev Respir Dis 137:1280–1284
    • View reference on PubMed
  36. Griffith DE, Girard WM, Wallace RJ Jr (1993) Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. Am Rev Respir Dis 147:1271–1278
    • View reference on PubMed
  37. Han D, Lee KS, Koh WJ, Yi CA, Kim TS, Kwon OJ (2003) Radiographic and CT findings of nontuberculous mycobacterial pulmonary infection caused by Mycobacterium abscessus. AJR Am J Roentgenol 181:513–517
    • View reference on PubMed
  38. El-Solh AA, Nopper J, Abdul-Khoudoud MR, Sherif SM, Aquilina AT, Grant BJ (1998) Clinical and radiographic manifestations of uncommon pulmonary nontuberculous mycobacterial disease in AIDS patients. Chest 114:138–145
    • View reference on PubMed
    • View reference on publisher's website
  39. Kobashi Y, Yoshida K, Miyashita N, Niki Y, Oka M (2006) Relationship between clinical efficacy of treatment of pulmonary Mycobacterium avium complex disease and drug-sensitivity testing of Mycobacterium avium complex isolates. J Infect Chemother 12:195–202
    • View reference on PubMed
    • View reference on publisher's website
  40. Marras TK, Morris A, Gonzalez LC, Daley CL (2004) Mortality prediction in pulmonary Mycobacterium kansasii infection and human immunodeficiency virus. Am J Respir Crit Care Med 170:793–798
    • View reference on PubMed
    • View reference on publisher's website

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