Non-tuberculous slow-growing mycobacterial pulmonary infections in non-HIV-infected patients in south London.
BACKGROUND
UK data on slow-growing non-tuberculous mycobacterial (NTM) pulmonary infections are sparse and there is little consensus on optimal treatment regimens.


METHODS
This was a retrospective study of NTM pulmonary infections in a London teaching hospital. Inclusion criteria were culture of slow-growing mycobacteria between 2000 and 2007, age > 18 y, HIV-negative, and meeting American Thoracic Society criteria.


RESULTS
Fifty-seven patients were included; 68% were males and the median age was 61 y. Predisposing factors were smoking (70%), alcohol abuse (28%), and chronic obstructive pulmonary disease (37%). Cavitation (56%) and infiltrates (42%) were common radiological findings. The predominant organism was Mycobacterium kansasii (70%). Ninety-three percent of patients with M. kansasii, 63% with Mycobacterium avium intracellulare, 60% with Mycobacterium malmoense, and 25% with Mycobacterium xenopi had clinical disease. Of the 57 patients, 37 were treated and had follow-up data available. Most patients received 3 drugs: rifampicin, ethambutol, and clarithromycin or ciprofloxacin for at least 9 months. Thirty percent experienced drug side effects. M. kansasii treatment had a 100% cure and 10% relapse rate, but 15% died.


CONCLUSIONS
M. kansasii was the most common NTM and its isolation was predictive of clinical disease. Compared with other studies, treatment with 3 agents had a similar rate of cure and did not appear to reduce the relapse rate of disease, but did increase the risk of side effects.
Department of Infection, Guys' and St Thomas' NHS Foundation Trust, London, UK.
Bethany S
BS
Davies
Catherine H
CH
Roberts
Sunny
S
Kaul
John L
JL
Klein
Heather J
HJ
Milburn
D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008171:Lung Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000145:classification / Q000254:growth & development* / Q000302:isolation & purification; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D019909:Mycobacterium kansasii / Q000254:growth & development / Q000302:isolation & purification; D012189:Retrospective Studies; D016896:Treatment Outcome
D000904:Antibiotics, Antitubercular