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Risk Factors of Radiographic Progression and Outcome of Patients with Mycobacterium Kansasii Pulmonary Infection
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A2599 - Risk Factors of Radiographic Progression and Outcome of Patients with Mycobacterium Kansasii Pulmonary Infection
Author Block: C. Liu1, H. Huang2, M. Cheng2, P. Lu3, C. Shu1, J. Wang1, I. Chong4; 1Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, 2Kaohsiung Medical University, Kaohsiung, Taiwan, 3Laboratory Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, 4Kaohsiung Medical Univ, Kaohsiung, Taiwan.
Rationale: Traditionally, Mycobacterium kansasii (MK) has been considered as the most virulent nontuberculous mycobacteria (NTM). Its presence in the respiratory specimen, however, does not always represent pulmonary infection (PI). Since treatment for MK-PI is toxic and lengthy, identifying the priority group is necessary. This study aimed to investigate the factors predicting radiographic progression and outcome of MK-PI within one year. Methods: Patients with MK-PI diagnosed according to current guidelines in six hospitals in Taiwan (three each in northern and southern Taiwan) from 2010 to 2014 were identified. Medical records were reviewed to retrieve clinical characteristics, laboratory data, and radiographic findings at the onset of MK-PI. Predictors of radiographic progression within one year was investigated using multivariate logistic regression. One-year mortality rate was also reported. Results: A total of 118 MK-PI episodes were included. Radiographic progression occurred in 71 (60.2%) episodes. Among them, the 1-year mortality rate was 42% with a median survival of 71 days. All episodes with sputum acid-fast smear (AFS) grade ≥3 experienced radiographic progression. For the remaining, independent risk factors of radiographic progression were old age (age >65; OR: 3.14 [1.11-8.88]), no diabetes mellitus (OR: 6.21 [1.30-29.6]), pure MK in sputum (no other co-existing NTM; OR: 3.16 [1.04-9.54]), fibrocavitary pattern (OR: 3.21 [1.04-9.92]), and leukocyte >9000 /ul (OR: 3.67 [1.22-11.06]). Using the two criteria, sputum AFS grade ≥3 and presence of ≥3 of the five risk factors in those with sputum AFS ≤2, 89% of the MK-PI episodes that progressed within one year can be identified at the initial. Conclusions: Within one year, about two-thirds of MK-PI episodes progressed; and more than one-third of them died rapidly. Anti-MK treatment should be considered if high-grade AFS positivity or presence of 3 or more of the risk factors.
Author Block: C. Liu1, H. Huang2, M. Cheng2, P. Lu3, C. Shu1, J. Wang1, I. Chong4; 1Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, 2Kaohsiung Medical University, Kaohsiung, Taiwan, 3Laboratory Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, 4Kaohsiung Medical Univ, Kaohsiung, Taiwan.
Rationale: Traditionally, Mycobacterium kansasii (MK) has been considered as the most virulent nontuberculous mycobacteria (NTM). Its presence in the respiratory specimen, however, does not always represent pulmonary infection (PI). Since treatment for MK-PI is toxic and lengthy, identifying the priority group is necessary. This study aimed to investigate the factors predicting radiographic progression and outcome of MK-PI within one year. Methods: Patients with MK-PI diagnosed according to current guidelines in six hospitals in Taiwan (three each in northern and southern Taiwan) from 2010 to 2014 were identified. Medical records were reviewed to retrieve clinical characteristics, laboratory data, and radiographic findings at the onset of MK-PI. Predictors of radiographic progression within one year was investigated using multivariate logistic regression. One-year mortality rate was also reported. Results: A total of 118 MK-PI episodes were included. Radiographic progression occurred in 71 (60.2%) episodes. Among them, the 1-year mortality rate was 42% with a median survival of 71 days. All episodes with sputum acid-fast smear (AFS) grade ≥3 experienced radiographic progression. For the remaining, independent risk factors of radiographic progression were old age (age >65; OR: 3.14 [1.11-8.88]), no diabetes mellitus (OR: 6.21 [1.30-29.6]), pure MK in sputum (no other co-existing NTM; OR: 3.16 [1.04-9.54]), fibrocavitary pattern (OR: 3.21 [1.04-9.92]), and leukocyte >9000 /ul (OR: 3.67 [1.22-11.06]). Using the two criteria, sputum AFS grade ≥3 and presence of ≥3 of the five risk factors in those with sputum AFS ≤2, 89% of the MK-PI episodes that progressed within one year can be identified at the initial. Conclusions: Within one year, about two-thirds of MK-PI episodes progressed; and more than one-third of them died rapidly. Anti-MK treatment should be considered if high-grade AFS positivity or presence of 3 or more of the risk factors.
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