Predictors of developing Mycobacterium kansasii pulmonary disease within 1 year among patients with single isolation in multiple sputum samples: A retrospective, longitudinal, multicentre study

Abstract

The clinical significance of a single Mycobacterium kansasii (MK) isolation in multiple sputum samples remains unknown. We conducted this study to evaluate the outcome and predictors of developing MK-pulmonary disease (PD) within 1 year among these patients. Patients with a single MK isolation from ≥3 sputum samples collected within 3 months and ≥2 follow-up sputum samples and chest radiography in the subsequent 9 months between 2008 and 2016 were included. The primary outcome was development of MK-PD within 1 year, with its predictors explored using multivariate logistic regression analysis. A total of 83 cases of a single MK isolation were identified. The mean age was 68.9 ± 17.9, with a male/female ratio of 1.96. Within 1 year, 16 (19%) cases progressed to MK-PD; risk factors included high acid-fast smear (AFS) grade (≥3), elementary occupation workers, and initial radiographic score >6, whereas coexistence with other nontuberculous mycobacterium species was protective. Among patients who developed MK-PD, all experienced radiographic progression, and 44% died within 1 year. Although a single MK isolation does not fulfil the diagnostic criteria of MK-PD, this disease may develop if having above-mentioned risk factors. Early anti-MK treatment should be considered for high-risk patients.

Figure 1

Flowchart of selection of new cases of Mycobacterium kansasii (MK) pulmonary disease (PD) in six hospitals.

Figure 2

Kaplan–Meier curves for time to development of Mycobacterium kansasii (MK) pulmonary disease (PD), stratified by coexistence of nontuberculous mycobacteria (NTM) species other than MK.