PMID- 26540302
OWN - NLM
STAT- MEDLINE
DCOM- 20161010
LR  - 20191210
IS  - 2325-6621 (Electronic)
IS  - 2325-6621 (Linking)
VI  - 13
IP  - 1
DP  - 2016 Jan
TI  - Improvement in Quality of Life after Therapy for Mycobacterium abscessus Group 
      Lung Infection. A Prospective Cohort Study.
PG  - 40-8
LID - 10.1513/AnnalsATS.201508-529OC [doi]
AB  - RATIONALE: Mycobacterium abscessus group lung infection is characterized by low 
      cure rates. Improvement in quality of life may be a reasonable treatment goal. 
      OBJECTIVES: The objective of this study was to evaluate change in quality of life 
      in response to therapy, predictors of improvement in quality of life, and 
      association of quality of life with traditional outcome measures. METHODS: 
      Forty-seven patients were treated for Mycobacterium abscessus group lung 
      infection (including one with Mycobacterium chelonae) and were followed 
      prospectively for 2 years between December 2009 and May 2012. St. George's 
      Respiratory Questionnaire (SGRQ) was administered, chest computed tomography (CT) 
      imaging was carried out, and culture data were collected at multiple time points. 
      Predictors of improvement in the SGRQ total score greater than or equal to a 
      minimal clinically important difference (MCID) at 12 months were evaluated. 
      MEASUREMENTS AND MAIN RESULTS: Patients were 85% female and 94% white, with a 
      mean age of 65 years. Nine (20%) had a genetic diagnosis of cystic fibrosis (none 
      F508del homozygous). Coinfection with Mycobacterium avium complex occurred in 28% 
      and Pseudomonas in 26%. Chest CT imaging universally indicated bronchiectasis and 
      nodules; 51% had lung cavities. Treatment included a mean of 17 months of 
      antibiotics, and lung resection in 34%. Seventeen patients with M. avium complex 
      (36%) and one with Mycobacterium kansasii were treated for coinfection. The mean 
      SGRQ total score (SD) at baseline was 35 (20). At all follow-up time points, the 
      mean SGRQ total score (SD) was significantly lower (better) than at baseline: 27 
      (17) at 3 months, P < 0.01; 27 (19) at 6 months, P < 0.01; 27 (20) at 12 months, 
      P < 0.01; and 30 (22) at 24 months, P = 0.02. At 12 and 24 months, respectively, 
      60% and 56% had improvement greater than or equal to the MCID in SGRQ total 
      score. Improvement greater than or equal to the MCID at 12 months was positively 
      associated with a history of respiratory exacerbation, isolate susceptible to 
      imipenem-cilastatin, and lung resection surgery, and negatively associated with 
      nodules >4 mm in diameter on chest CT imaging, but these associations were not 
      statistically significant in multivariable analysis. At 24 months, 16 patients 
      (48%) with complete data were culture negative for 1 year and had discontinued M. 
      abscessus group treatment. CONCLUSIONS: Quality of life was a sensitive indicator 
      of treatment response and has the potential to be a useful parameter to guide 
      treatment.
FAU - Czaja, Christopher A
AU  - Czaja CA
AD  - 1 Department of Medicine, National Jewish Health, Denver, Colorado.
AD  - 2 Department of Family Medicine.
FAU - Levin, Adrah R
AU  - Levin AR
AD  - 1 Department of Medicine, National Jewish Health, Denver, Colorado.
FAU - Cox, Christian W
AU  - Cox CW
AD  - 3 Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
FAU - Vargas, Daniel
AU  - Vargas D
AD  - 4 Department of Radiology, and.
FAU - Daley, Charles L
AU  - Daley CL
AD  - 1 Department of Medicine, National Jewish Health, Denver, Colorado.
AD  - 5 Department of Medicine, University of Colorado School of Medicine, Aurora, 
      Colorado; and.
FAU - Cott, Gary R
AU  - Cott GR
AD  - 1 Department of Medicine, National Jewish Health, Denver, Colorado.
AD  - 5 Department of Medicine, University of Colorado School of Medicine, Aurora, 
      Colorado; and.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Am Thorac Soc
JT  - Annals of the American Thoracic Society
JID - 101600811
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Aged
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Cohort Studies
MH  - Disease Management
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multiple Pulmonary Nodules/diagnosis/etiology
MH  - Mycobacterium Infections, 
      Nontuberculous/complications/diagnosis/*psychology/therapy
MH  - Mycobacterium avium Complex/isolation & purification
MH  - Mycobacterium chelonae/isolation & purification
MH  - Outcome Assessment, Health Care/methods
MH  - Pneumonectomy/*methods
MH  - Pneumonia, Bacterial/complications/diagnosis/microbiology/*psychology/therapy
MH  - Prospective Studies
MH  - *Quality of Life
MH  - Respiratory Function Tests/methods
MH  - Tomography, X-Ray Computed/methods
OTO - NOTNLM
OT  - X-ray computed tomography
OT  - nontuberculous mycobacteria
OT  - surgery
OT  - therapeutics
EDAT- 2015/11/06 06:00
MHDA- 2016/10/11 06:00
CRDT- 2015/11/06 06:00
PHST- 2015/11/06 06:00 [entrez]
PHST- 2015/11/06 06:00 [pubmed]
PHST- 2016/10/11 06:00 [medline]
AID - 10.1513/AnnalsATS.201508-529OC [doi]
PST - ppublish
SO  - Ann Am Thorac Soc. 2016 Jan;13(1):40-8. doi: 10.1513/AnnalsATS.201508-529OC.