title: Clinical and microbiologic outcomes in patients receiving treatment for Mycobacterium abscessus pulmonary disease.
abstract: BACKGROUND
  Mycobacterium abscessus can produce a chronic pulmonary infection for which little is known regarding optimal treatment and long-term outcomes.
  
  
  METHODS
  We performed a retrospective observational study (2001-2008) including all patients who met American Thoracic Society criteria for M. abscessus pulmonary disease. Our aim was the evaluation of clinical and microbiologic outcomes in patients treated with combined antibiotic and surgical therapy, compared with antibiotic therapy alone.
  
  
  RESULTS
  A total of 107 patients were included in the analysis. Patients were predominantly female (83%) and never-smokers (60%), with a mean age of 60 years. Fifty-nine (55%) of 107 patients had coexistent or previous history of Mycobacterium avium complex pulmonary infection. High-resolution chest CT showed bronchiectasis and nodular opacities in 98% of patients and cavities in 44%. Sixty-nine (46 medical, 23 surgical) patients were followed up for a mean duration of 34 months (standard deviation, 21.1 months, range, 2-82 months). Cough, sputum production, and fatigue remained stable, improved, or resolved in 80%, 69%, and 59% of patients, respectively. Twenty (29%) of 69 patients remained culture positive, 16 (23%) converted but experienced relapse, 33 (48%) converted to negative and did not experience relapse, and 17 (16%) died during the study period. There were significantly more surgical patients than medical patients whose culture converted and remained negative for at least 1 year (57% vs 28%; P = .022).
  
  
  CONCLUSIONS
  Patients with M. abscessus pulmonary disease who are treated with multidrug antibiotic therapy and surgery or antibiotic therapy alone had similar clinical outcomes. However, surgical resection, in addition to antibiotics, may offer a prolonged microbiologic response.
authors.affiliation: Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada. julie.jarand@albertahealthservices.ca
authors.forename: Julie
authors.initials: J
authors.lastname: Jarand
authors.forename: Adrah
authors.initials: A
authors.lastname: Levin
authors.forename: Lening
authors.initials: L
authors.lastname: Zhang
authors.forename: Gwen
authors.initials: G
authors.lastname: Huitt
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000187:drug effects / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents