Introduction Non-tuberculous mycobacteria (NTM) are often isolated in patients with chronic obstructive pulmonary disease (COPD). We sought to analyse the spectrum of NTM isolates, presentations and outcomes seen in COPD patients with NTM.
Methods All NTM isolates between 09/2010 and 10/2013 were identified from a prospective database of mycobacterial isolates. The electronic patient record was used to identify COPD patients. Information regarding radiology, bacteriology, spirometry, management, co-morbidity and outcomes was extracted.
Results Of 211 patients with NTM isolates, 59 (28%) had diagnosed COPD with a median FEV1 of 1.05L (range 0.59–2.94L). Forty-two (71%) were male and 21 (36%) current smokers. 21 had a known malignancy, 11 of which were lung cancer.
From the 59 patients, 118 samples were obtained. 50 patients isolated one NTM species with 9 isolating more than one species in the same or a subsequent sample. Isolated species are shown in Table 1.
Bacteria were isolated in 41 (69%), with Pseudomonas aeruginosa in 12 (20%). Eight patients (14%) had evidence of co-infection with aspergillus fumigatus. Radiological features varied, including predominant cavitation in 19 (32%), multiple nodules in 14 (17%), solitary nodules in 5 (8%) (all FDG-PET avid and diagnosed at resection for suspected lung cancer).
26 of 59 (44%) were commenced on anti-mycobacterial therapy, of which two (8%) remain on treatment. 15 (58%) commenced treatment but were unable to complete the prescribed course. Of these, 7 (47%) subsequently died while 8 (53%) remain stable off treatment. Of the 9 patients who completed treatment, 6 (67%) relapsed, of which 5 subsequently died. Of the 3 that did not relapse, 1 died. In total, 21 of 59 (36%) have died; 13 of 26 (50%) who commenced treatment and 8 of 33 (24%) who did not. Median time from first NTM presentation to death was 8 months (range 0–36).
Conclusions These data demonstrate often poor outcomes for COPD patients in whom NTM are isolated. The frequent presence of advanced COPD, co-existing infections and malignancy suggest the need for a holistic approach to therapeutic decision making including the need for palliative and end-of-life care.
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