Nontuberculous mycobacteria pulmonary infection in medical intensive care unit: the incidence,patient characteristics,and clinical significance |
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Authors: | Chin-Chung Shu Chih-Hsin Lee Jann-Yuan Wang Jih-Shuin Jerng Chong-Jen Yu Po-Ren Hsueh Li-Na Lee Pan-Chyr Yang the TAMI group |
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Institution: | (1) Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun Lin, Taiwan;(2) Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan;(3) Department of Internal Medicine, National Taiwan University Hospital, # 7, Chung-Shan South Road, Taipei, 100, Taiwan;(4) Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;(5) Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan; |
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Abstract: | Background The clinical significance of nontuberculous mycobacteria (NTM) pulmonary infection in medical intensive care unit (ICU) is
still unclear.
Materials and methods We conducted a retrospective study in the medical ICUs of a medical center in Taiwan from January 1999 to June 2007. Patients
with NTM isolated from respiratory specimens within 1 month before or during the ICU course were identified. Those who fulfilled
the diagnostic criteria of NTM pulmonary infection were identified and compared with patients with NTM colonization and control
subjects who were culture-negative for mycobacteria.
Results Among the 5,378 patients admitted to medical ICUs, 2,866 (53.3%) had received mycobacterial culture for respiratory specimens.
NTM were isolated from 169 (5.8%) patients. Of them, 47 (27.8%) were considered NTM pulmonary infection. M. avium complex and M. abscessus were the most common pathogens. Within 100 days after ICU admission, significantly more patients with NTM infection died
than those with NTM colonization and control subjects (47 vs. 8 vs. 14%, P < 0.001). Twenty-one (49%) patients with NTM pulmonary infection received anti-NTM treatment, with four experiencing adverse
effects. Although statistically insignificant, anti-NTM treatment was associated with prolonged survival for those who died
in the ICU and shorter ICU stay for those who survived the ICU course.
Conclusion Our findings suggest that NTM pulmonary infection seems to associate with higher mortality in medical ICUs. Anti-NTM treatment
is probably associated with a better outcome. Therefore, keeping a high suspicion when NTM is isolated and using careful consideration
when starting anti-NTM treatment should be emphasized.
Taiwan Anti-Mycobacteria Investigation (TAMI) group: J.-Y. Wang, L.-N. Lee, C.-J. Yu, P.-C. Yang, W.-J. Su, C.-C. Shu, H.-C.
Lai, C.-H. Lee and M.-C. Yu. |
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Keywords: | Nontuberculous mycobacteria Pulmonary infection Intensive care unit |
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