Reduced risk of nontuberculous mycobacteria in cystic fibrosis adults receiving long-term azithromycin.
BACKGROUND
Azithromycin reduces exacerbations in cystic fibrosis (CF) patients. Our aim was to investigate its association with nontuberculous mycobacteria isolation and macrolide susceptibility.


METHODS
From 2006 to 2010, all adult CF subjects at Cochin Hospital (Paris, France) harboring at least one positive NTM isolate were identified (Cases). In a nested case-control study, each Case was individually matched for age and gender with up to 4 CF adults with no NTM isolate (Controls). Clinical data at the time of first NTM isolate (index date) in Cases were compared with those of Controls using multivariate conditional regression analysis.


RESULTS
CF subjects with positive NTM isolates (Cases, n=41) were matched to 155 Controls. Among Cases, 48.7% had isolates from Mycobacterium avium complex and 58.5% from Mycobacterium abscessus complex, and 31 Cases fulfilled the 2007 American Thoracic Society criteria for NTM infection (ATS+ Cases). Cases and ATS+ Cases were more likely to have low body mass index and colonization with Aspergillus fumigatus. Azithromycin was associated with a two-fold reduction in NTM isolates. Only one M. avium complex isolate had acquired macrolide resistance.


CONCLUSIONS
These data suggest that azithromycin is a primary prophylaxis for NTM infection in CF adults.
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Nathalie
N
Coolen
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Bactériologie, Hôpital Cochin, AP-HP, Paris, France.
Philippe
P
Morand
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Clémence
C
Martin
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Dominique
D
Hubert
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Reem
R
Kanaan
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Jeanne
J
Chapron
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Isabelle
I
Honoré
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France.
Daniel
D
Dusser
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service d'Informatique Médicale et de Biostatistiques, Hôpital Cochin, AP-HP, Paris, France.
Etienne
E
Audureau
Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), F-75013 Paris, France; INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), F-75013 Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, F-75013 Paris, France.
Nicolas
N
Veziris
Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Pneumologie, Hôpital Cochin, AP-HP, Paris, France. Electronic address: pierre-regis.burgel@cch.aphp.fr.
Pierre-Régis
PR
Burgel
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017963:Azithromycin / Q000008:administration & dosage*; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D017963:Azithromycin
Aspergillus fumigatus; Cystic fibrosis; Macrolides; Nontuberculous mycobacteria; Risk factors