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Comparative Study
. 2017 Jul;14(7):1112-1119.
doi: 10.1513/AnnalsATS.201610-800OC.

Mortality after Respiratory Isolation of Nontuberculous Mycobacteria. A Comparison of Patients Who Did and Did Not Meet Disease Criteria

Shannon A Novosad  1 , Emily Henkle  2 , Sean Schafer  3 , Katrina Hedberg  3 , Jennifer Ku  4 , Sarah A R Siegel  2 , Dongseok Choi  2   5 , Christopher G Slatore  1   6 , Kevin L Winthrop  2   4
Affiliations
Comparative Study

Mortality after Respiratory Isolation of Nontuberculous Mycobacteria. A Comparison of Patients Who Did and Did Not Meet Disease Criteria

Shannon A Novosad et al. Ann Am Thorac Soc. 2017 Jul.

Abstract

Rationale: The mortality of patients with respiratory tract isolates of nontuberculous mycobacteria (NTM) and their risk factors for death are not well described.

Objectives: To determine age-adjusted mortality rates for patients with respiratory NTM isolates and their causes of death and to examine whether American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) diagnostic criteria identify those at higher risk of death after NTM isolation.

Methods: We linked vital records registries with a previously identified Oregon population-based cohort of patients with NTM respiratory isolation. We excluded patients with Mycobacterium gordonae (n = 33) and those who died (n = 21) at the time of first isolation. We calculated 5-year age-adjusted mortality rates. We used Kaplan-Meier and Cox proportional hazards analysis to examine the association of ATS/IDSA criteria and other risk factors with death.

Results: Of 368 subjects with respiratory NTM isolates in 2005-2006, 316 were included in the survival analysis. Most (84%) of their cultures isolated Mycobacterium avium complex. 35.1% died in the 5 years following respiratory isolation. Five-year age-adjusted mortality rates were slightly higher for those meeting (28.7/1,000) versus not meeting (23.4/1,000) ATS/IDSA criteria. In multivariate analysis, older age (adjusted hazard ratio [aHR], 1.06; 95% confidence interval [CI], 1.04-1.07) and lung cancer (aHR, 2.77; 95% CI, 1.51-5.07) were associated with an increased risk of death. A trend was noted between meeting ATS/IDSA criteria and subsequent death (aHR, 1.37; 95% CI, 0.95-1.97). Among cases, male sex, older age, and immunosuppressive therapy use were independent risk factors for death.

Conclusions: In the State of Oregon, patients with NTM respiratory isolates have high mortality, regardless of whether they meet ATS/IDSA criteria for pulmonary NTM disease. Most patients die as a result of causes other than NTM infection.

Keywords: mortality; natural history; nontuberculous mycobacteria.

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Figures

Figure 1.
Figure 1.
Oregon nontuberculous mycobacteria (NTM) cohort identification and study population flow diagram.
Figure 2.
Figure 2.
Kaplan-Meier survival curves showing probability of survival among those who did and did not meet American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) criteria; includes those subjects who survived at least 1 month and with a respiratory nontuberculous mycobacteria isolate other than Mycobacterium gordonae (n = 316). The solid line represents subjects who did not meet ATS/IDSA criteria (n = 138), and the dashed line represents subjects who did meet ATS/IDSA criteria (n = 178; hazard ratio, 1.15; 95% confidence interval, 0.82–1.62).
See this image and copyright information in PMC

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