Impact of bacterial co-isolation on treatment initiation and long-term prognosis of patients with nontuberculous mycobacterial pulmonary disease: analysis of a prospective cohort study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Mycobacterium Infections, Nontuberculous*/microbiology ; Mycobacterium Infections, Nontuberculous*/drug therapy ; Mycobacterium Infections, Nontuberculous*/mortality; Humans ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged ; Prognosis ; Sputum/microbiology ; Nontuberculous Mycobacteria/isolation & purification ; Anti-Bacterial Agents/therapeutic use ; Coinfection/microbiology ; Coinfection/drug therapy ; Lung Diseases/microbiology

Background: Nontuberculous mycobacterial pulmonary disease (NTM-PD), a chronic respiratory condition, presents a growing challenge globally. Uncertainties exist regarding the impact of concurrent bacterial co-isolation on treatment initiation and long-term prognosis.
Methods: This study analysed data from participants enrolled in an ongoing prospective observational cohort study on NTM-PD (NCT01616745) between 1 July 2011, and 31 December 2022, who provided sputum samples for bacterial culture at enrolment. Identification of potential pathogenic microorganisms (PPMs) was defined as a positive bacterial culture. Clinical characteristics were compared between NTM-PD patients with Pseudomonas, non-pseudomonal PPMs, and those without PPM co-isolation. Cox proportional hazard regression models were employed to assess the association of bacterial co-isolation with rates of NTM-PD treatment initiation and all-cause mortality.
Results: Overall, 453 patients (median age, 62 years; 30% male) were included in the analysis. PPMs were co-isolated in 77 patients (17%), including 13 with Pseudomonas species. Co-isolation of Pseudomonas was associated with a significantly higher erythrocyte sedimentation rate (P = 0.02) and St. George's Respiratory Questionnaire score (P = 0.01). Non-pseudomonal PPM co-isolation was significantly associated with a higher likelihood of NTM-PD treatment initiation (adjusted hazards ratio [aHR], 1.56, 95% confidence interval [CI], 1.03-2.36, P = 0.036), whereas co-isolation of Pseudomonas was independently correlated with increased all-cause mortality (aHR, 3.25, 95% CI, 1.08-9.84, P = 0.037).
Conclusions: Our findings emphasize the importance of microbial surveillance, as bacterial co-isolation affects treatment initiation and prognosis in patients with NTM-PD.
(© 2024. The Author(s).)

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Keywords: Pseudomonas; Bacterial co-isolation; Nontuberculous mycobacterial pulmonary disease; Potentially pathogenic microorganisms; Treatment initiation

0 (Anti-Bacterial Agents)

Date Created: 20241008 Date Completed: 20241009 Latest Revision: 20241011

20241011

PMC11462684

10.1186/s12879-024-10006-x

39379838