The influence of environmental exposure on the response to antimicrobial treatment in pulmonary Mycobacterial avium complex disease

BMC Infectious Diseases

Michiaki Mishima¹  Kaori Togashi²  Satoshi Ichiyama³  Koichi Maekawa⁴  Takeshi Kubo²  Kohei Fujita¹  Toyohiro Hirai¹  Yutaka Ito¹ 

[1] Department of Respiratory Medicine, Kyoto, Japan;Diagnostic Imaging and Nuclear Medicine, Kyoto, Japan;Clinical Laboratory Medicine, Kyoto University, Kyoto, Japan;Division of Respiratory Medicine, Takeda General Hospital, Kyoto, Japan

关键词: Relapse;    Environmental exposure;    Mycobacterium avium complex;   

Others  :  1125491
DOI  :  10.1186/1471-2334-14-522

 received in 2014-01-30, accepted in 2014-09-24,  发布年份 2014

【 摘 要 】

Background

Environmental exposure is a likely risk factor for the development of pulmonary Mycobacterium avium complex (MAC) disease. The influence of environmental exposure on the response to antimicrobial treatment and relapse is unknown.

Methods

We recruited 72 patients with pulmonary MAC disease (male [female], 18 [54]; age, 61.7 ± 10.3 years) who initiated and completed standard three-drug regimens for more than 12 months between January 2007 and December 2011. The factors associated with sputum conversion, relapse and treatment success without relapse were retrospectively evaluated after adjustments for confounding predictors.

Results

Fifty-two patients (72.2%) demonstrated sputum conversion, and 15 patients (28.8%) relapsed. A total of 37 patients (51.4%) demonstrated treatment success. Sputum conversion was associated with negative smears (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.27-12.60; P = 0.02). A relapse occurred in patients with low soil exposure after the start of treatment less frequently than in patients with high soil exposure (7/42 [16.7%] vs. 8/10 [80.0%], P = 0.0003). Treatment success was associated with low soil exposure after the beginning of treatment (OR, 13.46; 95% CI, 3.24-93.43; P = 0.0001) and a negative smear (OR, 2.97; 95% CI, 1.02-9.13; P = 0.047).

Conclusion

Low soil exposure was independently associated with better microbiological outcomes in patients with pulmonary MAC disease after adjusting for confounding clinical, microbiological and radiographic findings.

【 授权许可】

   
2014 Ito et al.; licensee BioMed Central Ltd.

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