Relapse versus Reinfection of Mycobacterium avium Complex Pulmonary Disease. Patient Characteristics and Macrolide Susceptibility

Abstract

Rationale: Clinical recurrence of Mycobacterium avium complex (MAC) pulmonary disease occurs in 10 to 40% of patients treated for this disease process. Episodes of clinical recurrence may represent true relapse from the same MAC strain or reinfection with a new strain.

Objectives: The purpose of this study was to investigate the clinical implications of separating patients into these two groups.

Methods: This retrospective study evaluated patients with a clinical recurrence of MAC pulmonary disease at our institution from 2000 to 2012. Isolates were genotyped using pulsed-field gel electrophoresis to differentiate relapse versus reinfection. Change in macrolide susceptibility was also analyzed.

Measurements and main results: In our cohort, 25% of patients suffered a clinical recurrence. Of the 46 included patients, 25 (54%) suffered a true relapse and 21 (46%) had a reinfection. Median time between completion of therapy and clinical recurrence was significantly lower in the relapse group compared with the reinfection group (210 d vs. 671 d; P = 0.004). The measured convalescent macrolide minimum inhibitory concentrations were significantly more likely to increase in the relapse group compared with the reinfection group (80 vs. 33%; P = 0.002). No differences in clinical outcomes were observed between the two groups at conclusion of the study.

Conclusions: Our findings suggest that patients with true relapse of MAC pulmonary disease present earlier than those with reinfection. Routine use of pulsed-field gel electrophoresis in the management of clinical recurrences may be beneficial, as those suffering a relapse are more likely to have increasing macrolide minimum inhibitory concentrations than those with reinfection.

Keywords: antibiotic resistance; nontuberculous mycobacteria; recurrence.