Nontuberculous mycobacteria infection and pulmonary disease in bronchiectasis

Kseniia Suska; Francesco Amati; Giovanni Sotgiu; Andrea Gramegna; Marco Mantero; Margherita Ori; Maurizio Ferrarese; Luigi Ruffo Codecasa; Anna Stainer; Francesco Blasi; Stefano Aliberti

doi:10.1183/23120541.00060-2022

Nontuberculous mycobacteria infection and pulmonary disease in bronchiectasis

ERJ Open Res. 2022 Dec 12;8(4):00060-2022. doi: 10.1183/23120541.00060-2022. eCollection 2022 Oct.

Authors

Kseniia Suska¹, Francesco Amati^{2

3}, Giovanni Sotgiu⁴, Andrea Gramegna^{5

6}, Marco Mantero^{5

6}, Margherita Ori^{5

6}, Maurizio Ferrarese⁷, Luigi Ruffo Codecasa⁷, Anna Stainer^{2

3}, Francesco Blasi^{5

6}, Stefano Aliberti^{2

3}

Affiliations

¹ Dept of Occupational Diseases, Clinical Immunology and Clinical Pharmacology, Dnipro State Medical University, Dnipro, Ukraine.
² Dept of Biomedical Sciences, Humanitas University, Milan, Italy.
³ Respiratory Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
⁴ Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
⁵ Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁶ Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
⁷ Regional TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy.

Abstract

Background: Although interest in nontuberculous mycobacteria (NTM) infection has increased in the last decades, published data vary according to different geographical areas, diagnostic facilities and quality of study design. This study aims at assessing both prevalence and incidence of NTM infection and NTM pulmonary disease (NTM-PD) among adults with bronchiectasis, to describe patients' characteristics, therapeutic options and clinical outcomes.

Methods: Bronchiectasis adults who had been tested for NTM were enrolled at the Bronchiectasis Program of the Policlinico Hospital in Milan, Italy, from 2016 to 2018.

Results: Among the 373 patients enrolled, 26.1% had at least one respiratory sample positive for NTM and 12.6% reached a diagnosis of NTM-PD. Incidence rates for NTM infection and NTM-PD were 13 (95% CI 10-16) and 4 (95% CI 2-6) per 100 person-years, respectively. The most prevalent NTM species causing NTM-PD were M. intracellulare (38.3%), M. avium (34.0%), M. abscessus (8.5%) and M. kansasii (8.5%). Once treatment for NTM-PD was initiated, a favourable outcome was documented in 52.2% of the patients, while a negative outcome was recorded in 32.6%, including recurrence (17.4%), treatment failure (10.9%), re-infection (2.2%) and relapse (2.2%). Treatment halted was experienced in 11 (23.9%) patients.

Conclusions: NTM infection is frequent in bronchiectasis patients and the presence of NTM-PD is relevant. The low success rate of NTM-PD treatment in bronchiectasis patients requires a call to action to identify new treatment modalities and new drugs to improve patients' outcomes.