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Predictive risk factors of treatment-refractory Mycobacterium avium complex lung disease: a single-center
Takahiko Saito1, Yuya Aono2, Masato Kono1
1Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
Background:
Mycobacterium avium complex lung disease (MAC-LD) is a chronic, progressive, potentially life-threatening infection. Some cases are refractory to standard guideline-based therapy (GBT), and sputum cultures are persistently positive for acid-fast bacilli. Although an early identification of treatment-refractory MAC-LD is crucial, its risk factors remain unknown.
Objectives:
We aimed to identify the risk factors for refractory MAC-LD in response to initial GBT.
Design:
A retrospective single-center study was conducted involving consecutive patients with MAC-LD who were diagnosed between 2006 and 2024 and received initial GBT.
Methods:
Refractory MAC-LD was defined as sputum culture positivity at least 6 months after the initial GBT. Prognostic factors were identified using Cox proportional hazards analysis, and risk factors for refractory MAC-LD were examined using logistic regression analysis.
Results:
Of the 201 patients with definite MAC-LD, 35 (17.4%) had refractory MAC-LD. Patients with refractory MAC-LD had a significantly lower body mass index (BMI), more cavitary lesions on high-resolution computed tomography (HRCT), and higher mortality (log-rank test, p = 0.006) compared to those with non-refractory MAC-LD. A multivariate analysis adjusted for age and sex showed that refractory MAC-LD (adjusted hazard ratio (HR): 2.76; 95% confidence interval (CI): 1.10-6.95; p = 0.030) and cavitary lesions on HRCT (adjusted HR: 2.77; 95% CI: 1.34-5.70; p = 0.005) were significantly associated with all-cause mortality. In addition, a multivariate analysis revealed that lower BMI (odds ratio (OR): 0.68; 95% CI: 0.55-0.85; p < 0.001) and cavitary lesions on HRCT (OR: 2.52; 95% CI: 1.15-5.50; p = 0.020) were independent risk factors of refractory MAC-LD.
Conclusion:
Low BMI and cavitary lesions on HRCT are risk factors for refractory MAC-LD.
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Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...