Factors that affect sputum conversion and treatment outcome in patients with Mycobacterium avium-intracellulare complex pulmonary disease.
OBJECTIVE
To investigate factors that might affect the sputum conversion and treatment outcome of Mycobacterium avium-intracellulare complex (MAC) pulmonary disease.


METHODS
This retrospective study reviewed 46 patients diagnosed with MAC pulmonary disease at the Chang Gung Memorial Hospital at Linkou between July 1998 and February 2005. The diagnosis was based on the American Thoracic Society criteria for diagnosis of disease due to non-tuberculous mycobacteria of 1997.


RESULTS
Of the 46 patients reviewed, 30 were men and 16 women, with a mean age of 64.39 years (range, 28-87 years). Thirty one patients had preexisting lung diseases, including history of pulmonary tuberculosis in 23 patients. Follow-up of sputum cultures could be traced in 28 patients, and sputum conversion was found in 17 patients. Of the 28 patients, 9 were treated with anti-MAC drugs for <5 months or with a regimen not containing at least 2 anti-MAC drugs. These treatment regimens were significantly associated with failure of sputum conversion to culture negativity (adjusted odds ratio [OR], 16.83; 95% confidence interval [CI], 1.16-245.06; p=0.039). Eleven of the remaining 19 patients were treated with an anti-MAC regimen containing clarithromycin for >5 months. However, there was no statistically significant association between sputum conversion and clarithromycin-containing anti-MAC regimens (OR, 0.42; 95% CI, 0.08-2.16; p=0.435).


CONCLUSIONS
MAC pulmonary disease often occurs in the context of preexisting lung disease, especially pulmonary tuberculosis. Patients tend to be older. Inappropriate treatment might lead to failure of sputum conversion. Treatment with rational combination regimens for at least 5 months could be necessary for sputum conversion.
Ye
Jung-Jr
JJ
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan.
Wu
Ting-Shu
TS
Chiang
Ping-Cherng
PC
Lee
Ming-Hsun
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification*; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000382:microbiology
D000900:Anti-Bacterial Agents