Opinions differ by expertise in Mycobacterium avium complex disease

Area of Science:

• Pulmonology
• Infectious Diseases
• Clinical Practice Guidelines

Background:

• Pulmonary Mycobacterium avium complex (MAC) treatment guidelines are primarily based on expert opinion.
• The level of agreement between non-expert clinicians and experts on these recommendations is not well understood.

Purpose of the Study:

• To compare the clinical practices and perceived prognosis of pulmonary MAC infection between experts and non-experts.
• To identify potential discrepancies in the management and understanding of MAC disease between different levels of clinical expertise.

Main Methods:

• A survey was conducted among respirologists in Ontario, Canada (non-experts) and experts from nontuberculous mycobacterial disease centers of excellence in Canada and the United States.
• Responses from 46 Ontario respirologists and 19 experts were analyzed to compare their views on various aspects of MAC treatment and prognosis.

Main Results:

• High agreement was observed on disease duration, spontaneous remission likelihood, treatment duration, preferred initial therapy, and survival.
• Non-experts underestimated disease prevalence in culture-positive patients, used intensive guideline therapy less frequently, and perceived lower treatment success rates.
• Response variability was significantly wider among non-experts, particularly regarding intensive therapy selection for new and recurrent cases.

Conclusions:

• While experts and non-experts share common ground on many MAC treatment issues, notable differences exist in perceived disease rates and treatment outcomes.
• Non-experts demonstrated greater variability in their responses and tended towards less aggressive treatment strategies.
• These findings suggest potential areas for targeted educational interventions to align clinical practice with expert recommendations, despite possible referral bias.