The Association Between Sputum Culture Conversion and Mortality in Cavitary Mycobacterium avium Complex Pulmonary Disease
Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved..
BACKGROUND: The association between treatment outcome and the mortality of Mycobacterium avium complex pulmonary disease (MAC-PD) with cavitary lesions is unclear. This article assessed the impact of culture conversion on mortality in patients with cavitary MAC-PD.
RESEARCH QUESTION: Is the achievement of sputum culture conversion in MAC-PD with cavitary lesions associated with the prognosis?.
STUDY DESIGN AND METHODS: From 2002 to 2020, a total of 351 patients with cavitary MAC-PD (105 with the fibrocavitary type and 246 with the cavitary nodular bronchiectatic type), who had been treated with a ≥ 6-month macrolide-containing regimen at a tertiary referral center in the Republic of Korea, were retrospectively enrolled in this study. All-cause mortality during the follow-up period was analyzed based on culture conversion at the time of treatment completion.
RESULTS: The cohort had a median treatment duration of 14.7 months (interquartile range [IQR], 13.4-16.8 months). Of the 351 patients, 69.8% (245 of 351) achieved culture conversion, and 30.2% (106 of 351) did not. The median follow-up was 4.4 years (IQR, 2.3-8.3 years) in patients with culture conversion and 3.1 years (IQR, 2.1-4.8 years) in those without. For the patients with and without culture conversion, all-cause mortality was 5.3% vs 35.8% (P < .001), and the 5-year cumulative mortality was 20.0% vs 38.4%, respectively. Cox analysis found that a lack of culture conversion was significantly associated with higher mortality (adjusted hazard ratio, 5.73; 95% CI, 2.86-11.50). Moreover, the 2-year landmark analysis revealed a distinct impact of treatment outcome on mortality.
INTERPRETATION: The mortality rate of patients with cavitary MAC-PD who did not achieve culture conversion was significantly higher than that of those with culture conversion.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Chest - (2024) vom: 18. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lee, Ju Kwang [VerfasserIn] |
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| Links: |
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| Themen: |
All-cause mortality |
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| Anmerkungen: |
Date Revised 13.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.chest.2024.03.027 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369979141 |
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| 520 | |a Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The association between treatment outcome and the mortality of Mycobacterium avium complex pulmonary disease (MAC-PD) with cavitary lesions is unclear. This article assessed the impact of culture conversion on mortality in patients with cavitary MAC-PD | ||
| 520 | |a RESEARCH QUESTION: Is the achievement of sputum culture conversion in MAC-PD with cavitary lesions associated with the prognosis? | ||
| 520 | |a STUDY DESIGN AND METHODS: From 2002 to 2020, a total of 351 patients with cavitary MAC-PD (105 with the fibrocavitary type and 246 with the cavitary nodular bronchiectatic type), who had been treated with a ≥ 6-month macrolide-containing regimen at a tertiary referral center in the Republic of Korea, were retrospectively enrolled in this study. All-cause mortality during the follow-up period was analyzed based on culture conversion at the time of treatment completion | ||
| 520 | |a RESULTS: The cohort had a median treatment duration of 14.7 months (interquartile range [IQR], 13.4-16.8 months). Of the 351 patients, 69.8% (245 of 351) achieved culture conversion, and 30.2% (106 of 351) did not. The median follow-up was 4.4 years (IQR, 2.3-8.3 years) in patients with culture conversion and 3.1 years (IQR, 2.1-4.8 years) in those without. For the patients with and without culture conversion, all-cause mortality was 5.3% vs 35.8% (P < .001), and the 5-year cumulative mortality was 20.0% vs 38.4%, respectively. Cox analysis found that a lack of culture conversion was significantly associated with higher mortality (adjusted hazard ratio, 5.73; 95% CI, 2.86-11.50). Moreover, the 2-year landmark analysis revealed a distinct impact of treatment outcome on mortality | ||
| 520 | |a INTERPRETATION: The mortality rate of patients with cavitary MAC-PD who did not achieve culture conversion was significantly higher than that of those with culture conversion | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Lee, Hyun Joo |e verfasserin |4 aut | |
| 700 | 1 | |a Shim, Tae Sun |e verfasserin |4 aut | |
| 700 | 1 | |a Jo, Kyung-Wook |e verfasserin |4 aut | |
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