PMID- 30547753 OWN - NLM STAT- MEDLINE DCOM- 20190115 LR - 20200225 IS - 1471-2334 (Electronic) IS - 1471-2334 (Linking) VI - 18 IP - 1 DP - 2018 Dec 14 TI - A retrospective study of factors associated with treatment decision for nontuberculous mycobacterial lung disease in adults without altered systemic immunity. PG - 659 LID - 10.1186/s12879-018-3559-x [doi] LID - 659 AB - BACKGROUND: Nontuberculous mycobacteria (NTM) lung diseases are increasingly recognized as chronic opportunistic infections, occurring in individuals with a wide variety of underlying conditions. In the absence of systemic immunodeficiency, decision of NTM lung disease treatment must relies on a careful risk/benefit assessment, given the requirement of long-term administration of multidrug therapies supported by limited evidence. The primary objective was to identify the factors associated with anti-NTM treatment initiation. Clinical and radiological outcome upon treatment were studied. METHODS: This retrospective, single center study (2013-2016, 45 months) addressed the criteria supporting treatment decision among adults with NTM lung disease without systemic immunodeficiency at our institution, with the assigned goal to harmonize the practice. All patients matched the current international definitions of NTM lung disease according to the American Thoracic Society criteria. Factors associated with anti-NTM treatment were investigated by conditional logistic regression. Clinical and radiological outcomes of treated and untreated NTM-disease cases were examined. Mortality rate was assessed. An expert radiologist conducted a blinded computed tomography (CT)-scan review of the treated and untreated patients. RESULTS: Among 51 cases of NTM lung diseases, 25 (49%) received anti-NTM treatment. In univariate analysis, a body mass index (BMI) < 18 kg/m(2) (odds ratio (OR), 4.2 [95% confidence interval (CI) 1.2-15.2]; p = 0.042), hemoptysis (OR, 11.8 [95% CI 1.35-12.9]; p = 0.026), excavation(s) (OR, 4.8 [95% CI 1.4-16.4], p = 0.012), prior anti-NTM treatment (OR, 5.65 [95% CI 1.06-29.9]; p = 0.042), Aspergillus spp. co-infection (OR, 6.3 [95% CI 1.8-22.2]; p = 0.004) were associated with treatment initiation. In multivariate analysis, Aspergillus spp. co-infection was the only independent determinant of treatment initiation (OR, 5.3 [95% CI 1.1-25.4]; p = 0.036). Twenty-one (81%) patients received >/=3 anti-NTM drugs. Median treatment duration and follow-up were 36.3 (interquartile range [IQR], 13.1-64.4) weeks and 17.1 (IQR, 8.7-27.1) months, respectively. Regarding radiological outcome, 85 CT-scans were reviewed, showing similar rates of regression or stabilization in treated and untreated patients. Overall mortality rate was not different in treated and untreated patients. CONCLUSION: The most relevant variable associated with anti-NTM treatment initiation was Aspergillus spp. co-infection. Radiological regression or stabilization of pulmonary lesions was not different between the treated and untreated patients. FAU - Provoost, Judith AU - Provoost J AD - Departement de Pneumologie, Hospices Civils de Lyon, Lyon, France. FAU - Valour, Florent AU - Valour F AD - Departement des Maladies infectieuses et tropicales, Hopital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France. AD - CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Universite Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Superieure de Lyon, Univ Lyon, F-69007, Lyon, France. AD - Universite Claude Bernard Lyon 1, Lyon, France. FAU - Gamondes, Delphine AU - Gamondes D AD - Departement de Radiologie, Hospices Civils de Lyon, Lyon, France. FAU - Roux, Sandrine AU - Roux S AD - Departement des Maladies infectieuses et tropicales, Hopital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France. FAU - Freymond, Nathalie AU - Freymond N AD - Departement de Pneumologie, Hospices Civils de Lyon, Lyon, France. FAU - Perrot, Emilie AU - Perrot E AD - Departement de Pneumologie, Hospices Civils de Lyon, Lyon, France. FAU - Souquet, Pierre-Jean AU - Souquet PJ AD - Departement de Pneumologie, Hospices Civils de Lyon, Lyon, France. AD - Universite Claude Bernard Lyon 1, Lyon, France. FAU - Kiakouama-Maleka, Lize AU - Kiakouama-Maleka L AD - Departement de Pneumologie, Hospices Civils de Lyon, Lyon, France. FAU - Chidiac, Christian AU - Chidiac C AD - Departement des Maladies infectieuses et tropicales, Hopital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France. AD - Universite Claude Bernard Lyon 1, Lyon, France. FAU - Lina, Gerard AU - Lina G AD - CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Universite Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Superieure de Lyon, Univ Lyon, F-69007, Lyon, France. AD - Universite Claude Bernard Lyon 1, Lyon, France. AD - Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France. FAU - Dumitrescu, Oana AU - Dumitrescu O AD - CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Universite Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Superieure de Lyon, Univ Lyon, F-69007, Lyon, France. AD - Universite Claude Bernard Lyon 1, Lyon, France. AD - Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France. FAU - Senechal, Agathe AU - Senechal A AD - Departement de Pneumologie, Hospices Civils de Lyon, Lyon, France. FAU - Ader, Florence AU - Ader F AD - Departement des Maladies infectieuses et tropicales, Hopital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France. florence.ader@chu-lyon.fr. AD - CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Universite Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Superieure de Lyon, Univ Lyon, F-69007, Lyon, France. florence.ader@chu-lyon.fr. AD - Universite Claude Bernard Lyon 1, Lyon, France. florence.ader@chu-lyon.fr. LA - eng PT - Journal Article DEP - 20181214 PL - England TA - BMC Infect Dis JT - BMC infectious diseases JID - 100968551 SB - IM MH - Adult MH - Clinical Decision-Making MH - Humans MH - Logistic Models MH - *Mycobacterium Infections, Nontuberculous/diagnostic imaging/epidemiology/therapy MH - Retrospective Studies PMC - PMC6295085 OTO - NOTNLM OT - Aspergillus spp. OT - Bronchiectasis OT - Chronic obstructive pulmonary disease OT - Hemoptysis OT - Mycobacteria OT - Mycobacterium avium complex OT - Nontuberculous mycobacteria COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The Ethics Committee of Lyon University Hospital (Comite d'Ethique, Hospices Civils de Lyon) approved the study under the number 17-207. Because of the retrospective observational nature of the study and the lack of any modification in patients' management, the need for informed consent was waived with the authorization of the Ethics Committee of Lyon University Hospital (Comite d'Ethique, Hospices Civils de Lyon), which approved the study under the number 17-207. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. No writing assistance was utilized in the production of this manuscript. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2018/12/15 06:00 MHDA- 2019/01/16 06:00 PMCR- 2018/12/14 CRDT- 2018/12/15 06:00 PHST- 2018/07/01 00:00 [received] PHST- 2018/11/26 00:00 [accepted] PHST- 2018/12/15 06:00 [entrez] PHST- 2018/12/15 06:00 [pubmed] PHST- 2019/01/16 06:00 [medline] PHST- 2018/12/14 00:00 [pmc-release] AID - 10.1186/s12879-018-3559-x [pii] AID - 3559 [pii] AID - 10.1186/s12879-018-3559-x [doi] PST - epublish SO - BMC Infect Dis. 2018 Dec 14;18(1):659. doi: 10.1186/s12879-018-3559-x.