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The following is a summary of “Microbiological Cure at Treatment Completion Is Associated With Longer Survival in Patients With Mycobacterium avium Complex Pulmonary Disease,” published in the November 2023 issue of CHEST by Kim et al.

Nontuberculous mycobacterial lung disease (NTM-PD) is making more people sick and killing more of them. Most of the time, NTM-PD is caused by Mycobacterium avium complex (MAC). Microbiological results are often used as the primary measure of success in antibiotic treatment, but how they will affect outlook, in the long run, needs to be clarified. For a study, researchers sought to know if people who get a medical cure at the end of their treatment live longer than people who don’t.

They looked back at adult patients who had NTM-PD, were infected with MAC species, and were treated with a macrolide-based treatment for at least 12 months, as recommended by guidelines, from January 2008 to May 2021 at a major referral center. A mycobacterial culture was done during antibiotic treatment to check the microbiology result. Microbiological cure was reached for patients with three or more negative cultures taken in a row, at least 4 weeks apart, and no positive cultures until the end of their treatment. They did a modified Cox proportional hazards regression analysis that considered age, sex, BMI, the appearance of cavitary tumors, erythrocyte sedimentation rate, and other underlying conditions. This helped them figure out how bacterial treatment affected death from all causes. Of the 382 admitted patients, 236 (61.8%) were microbiologically cured by the end of treatment. 

People in this group were younger, had lower erythrocyte sedimentation rates, were less likely to use 4 or more drugs, and were treated for less time than people who did not get a microbial fix. About 53 patients died between the first and third quartiles, or 3.2 to 5.4 years, after the end of their care. After considering the most important clinical factors, microbiological cure was strongly linked to lower mortality (adjusted hazard ratio, 0.52; 95% CI, 0.28–0.94). A sensitivity study that included all patients treated in the past 12 months kept the link between bacterial treatment and death.

Patients with MAC-PD are more likely to live longer if they are microbiologically cured at the end of their treatment.

Source: sciencedirect.com/science/article/abs/pii/S0012369223008942