Type of publication:
Conference abstract
Author(s):
*Ibrahim J.; *Ali A.; *Mahmoud M.; *Hamze H.; *Crawford E.; *Makan A.; *Srinivasan K.; *Moudgil H.; *Ahmad N.
Citation:
American Journal of Respiratory and Critical Care Medicine; May 2019; vol. 199 (no. 9)
Abstract:
Introduction Prevalence of NTM varies worldwide. Guidelines for the diagnosis and management of Pulmonary NTM have been published recently and in light of this; we aimed to look at our local data of NTM isolates with particular attention to the pulmonary isolates. Methods Patient details were obtained for all positive NTM isolates from 2002 to 2017. Further details on microbiology, radiology and treatment of these patients were searched from clinical portal, Patient archives communication system for radiology and outpatient clinic letters. Results 147 NTM were isolated from pulmonary and extra pulmonary sites (figure 1). This included 53% (n=78) female patients with a mean age (SD) of 62 (21) years. 90 pulmonary isolates were considered for further analysis. 33/90 (37%) received treatment with >=3 drugs (n = 19), <=2 drugs (n = 13) and data unavailable for one patient. Where data on duration of treatment was available (n = 30), 19/30 (63%) were treated for >=18 months and 11 (37%) treated for <18 months. With reference to current guidelines [1][2], 25/90 met microbiological and radiological criteria for treatment, 15/25 (60%) were treated, 8 (32%) not treated and no data on treatment available for the remaining 2 (8%). NTM types treated include Mycobacterium Avium Complex (MAC) (n=18), M.Malmonse (n=6), M.Kansasii (n=4), M.Szulgai (n=2), M.Abscessus (n=1), M.Gordonae (n=1), M.Xenopi (n=1). 78/90 (87%) patients had underlying lung disease. Of these most common were COPD (27), bronchiectasis (27), Asthma (13), Aspergillus infection/sensitization (7), Cystic Fibrosis (3) and previous TB (3). Conclusion Our local data prior to the publishing of current guidelines shows 40% couldn't be treated for NTM disease. This may be due to the challenges of age at diagnosis, risk of side effects, difficulty in differentiation between colonised or pathological isolate; looking ahead, the current guidance may enable a more standardised approach towards diagnosis and management.
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