Factors which influence treatment initiation for pulmonary non-tuberculous mycobacterium infection in HIV negative patients; a multicentre observational study.
Clinical, radiological and microbiological criteria inform diagnosis of pulmonary Non-Tuberculous Mycobacteria (NTM) disease and treatment decisions. This multicentre, review aims to characterise NTM disease meeting ATS/IDSA criteria and define factors associated with initiation of treatment.



Sputum samples growing NTM from 5 London hospitals between 2010 and 2014 were identified. Data for HIV-negative individuals meeting ATS/IDSA guidelines for pulmonary NTM disease were extracted. Associations between clinical variables and treatment decision were investigated using Chi-squared, Fishers-exact or Mann Whitney tests. Factors associated with treatment in univariate analysis (p < 0.150) were included in a multivariate logistic regression model.



NTM were identified from 817 individuals' sputum samples. 108 met ATS/IDSA criteria. 42/108 (39%) were initiated on treatment. Median age was 68 (56-78) in the cohort. On multivariate analysis, factors significantly associated with treatment of pulmonary NTM infection were: Cavitation on HRCT (OR: 6.49; 95% CI: 2.36-17.81), presenting with night sweats (OR 4.18; 95% CI: 1.08-16.13), and presenting with weight loss (OR 3.02; 95% CI: 1.15-7.93). Of those treated, 18(43%) have completed treatment, 9(21%) remain on treatment, 10(24%) stopped due to side effects, 5(12%) died during treatment. Mortality was 31% (n = 13) in treated versus 21% (n = 14) in the non-treated cohort. Subgroup analysis of individual NTM species did not observe any differences in treatment initiation or outcomes between groups.



Decision to treat pulmonary NTM infection requires clinical judgement when interpreting clinical guidelines. Factors independently associated with decision to treat in this HIV-negative cohort include cavitation on HRCT and presenting with night sweats or weight loss.
Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK. Electronic address: timothy.rawson07@imperial.ac.uk.
Timothy M
TM
Rawson
Imperial College London, London, UK; London North West Healthcare NHS Trusts, London, UK.
Aula
A
Abbara
National Mycobacterium Reference Laboratory, Whitechapel, London, UK; National Mycobacterium Reference Laboratory, Forschungszentrum Borstel, Germany.
Katharina
K
Kranzer
Imperial College Healthcare NHS Trust, London, UK.
Andrew
A
Ritchie
Imperial College Healthcare NHS Trust, London, UK.
James
J
Milburn
National Mycobacterium Reference Laboratory, Whitechapel, London, UK.
Tim
T
Brown
London North West Healthcare NHS Trusts, London, UK.
David
D
Adeboyeku
London North West Healthcare NHS Trusts, London, UK.
Jim
J
Buckley
London North West Healthcare NHS Trusts, London, UK.
Robert N
RN
Davidson
Imperial College Healthcare NHS Trust, London, UK.
Matthew
M
Berry
Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK.
Onn Min
OM
Kon
London North West Healthcare NHS Trusts, London, UK.
Laurence
L
John
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D018023:HIV Seronegativity / Q000187:drug effects*; D006801:Humans; D008131:London / Q000453:epidemiology; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D019909:Mycobacterium kansasii / Q000187:drug effects / Q000302:isolation & purification; D019912:Mycobacterium xenopi / Q000187:drug effects / Q000302:isolation & purification; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D015995:Prevalence; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D006113:United Kingdom
D000900:Anti-Bacterial Agents
Anti-mycobacterial chemotherapy; Epidemiology; Factors influencing treatment; HIV-Negative; Non-tuberculous mycobacterium