Nontuberculous mycobacteria pulmonary infection in medical intensive care unit

The incidence, patient characteristics, and clinical significance

Chin Chung Shu, Chih Hsin Lee, Jann Yuan Wang, Jih Shuin Jerng, Chong Jen Yu, Po Ren Hsueh, Li Na Lee, Pan Chyr Yang, J. Y. Wang, L. N. Lee, C. J. Yu, P. C. Yang, W. J. Su, C. C. Shu, H. C. Lai, C. H. Lee, M. C. Yu

Research output: Contribution to journalArticle

27 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2194-2201
Number of pages8
JournalIntensive Care Medicine
Volume34
Issue number12
DOIs
Publication statusPublished - Dec 2008
Externally publishedYes

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Nontuberculous Mycobacterium Infections
Nontuberculous Mycobacteria
Intensive Care Units
Lung
Incidence
Therapeutics
Mycobacterium
Taiwan
Retrospective Studies

Keywords

  • Intensive care unit
  • Nontuberculous mycobacteria
  • Pulmonary infection

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Nontuberculous mycobacteria pulmonary infection in medical intensive care unit : The incidence, patient characteristics, and clinical significance. / Shu, Chin Chung; Lee, Chih Hsin; Wang, Jann Yuan; Jerng, Jih Shuin; Yu, Chong Jen; Hsueh, Po Ren; Lee, Li Na; Yang, Pan Chyr; Wang, J. Y.; Lee, L. N.; Yu, C. J.; Yang, P. C.; Su, W. J.; Shu, C. C.; Lai, H. C.; Lee, C. H.; Yu, M. C.

In: Intensive Care Medicine, Vol. 34, No. 12, 12.2008, p. 2194-2201.

Research output: Contribution to journalArticle

Shu, CC, Lee, CH, Wang, JY, Jerng, JS, Yu, CJ, Hsueh, PR, Lee, LN, Yang, PC, Wang, JY, Lee, LN, Yu, CJ, Yang, PC, Su, WJ, Shu, CC, Lai, HC, Lee, CH & Yu, MC 2008, 'Nontuberculous mycobacteria pulmonary infection in medical intensive care unit: The incidence, patient characteristics, and clinical significance', Intensive Care Medicine, vol. 34, no. 12, pp. 2194-2201. https://doi.org/10.1007/s00134-008-1221-6
Shu, Chin Chung ; Lee, Chih Hsin ; Wang, Jann Yuan ; Jerng, Jih Shuin ; Yu, Chong Jen ; Hsueh, Po Ren ; Lee, Li Na ; Yang, Pan Chyr ; Wang, J. Y. ; Lee, L. N. ; Yu, C. J. ; Yang, P. C. ; Su, W. J. ; Shu, C. C. ; Lai, H. C. ; Lee, C. H. ; Yu, M. C. / Nontuberculous mycobacteria pulmonary infection in medical intensive care unit : The incidence, patient characteristics, and clinical significance. In: Intensive Care Medicine. 2008 ; Vol. 34, No. 12. pp. 2194-2201.
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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.",
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T2 - The incidence, patient characteristics, and clinical significance

AU - Shu, Chin Chung

AU - Lee, Chih Hsin

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AU - Jerng, Jih Shuin

AU - Yu, Chong Jen

AU - Hsueh, Po Ren

AU - Lee, Li Na

AU - Yang, Pan Chyr

AU - Wang, J. Y.

AU - Lee, L. N.

AU - Yu, C. J.

AU - Yang, P. C.

AU - Su, W. J.

AU - Shu, C. C.

AU - Lai, H. C.

AU - Lee, C. H.

AU - Yu, M. C.

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N2 - 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.

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