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Mycobacterium Chimaerain COPD Patients: Clinical, Radiological Features and Outcome
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A1981 - Mycobacterium Chimaerain COPD Patients: Clinical, Radiological Features and Outcome
Author Block: R. Lukaszewicz1, K. El Husseini2, S. Skalli3, L. Thiberville2, A. Cuvelier2, M. Patout1; 1Respiratory, thoracic oncology, intensive care unit, Rouen University Hospital, Rouen, France, 2Respiratory, thoracic oncology, intensive care unit, Rouen University Hospital, ROUEN, France, 3Microbiology, Rouen University Hospital, ROUEN, France.
BACKGROUND: Non-tuberculous mycobacteria (NTM) have a detrimental impact on the course of COPD. Mycobacterium chimaera (MC) has been identified recently. Data on COPD patients with MC are sparse. The aim of this study was to describe the clinical, radiological presentation and the outcome associated with MC isolation in COPD patients. METHODS: We performed a retrospective observational study. We included all patients with COPD and with at least one respiratory bacteriological sample positive for MC between 2009 and 2016. Patients data were recorded from electronic medical record. American Thoracic Society diagnostic criteria were used to distinguish disease from colonization. RESULTS: From the 123 MC isolates of our center, 24 (20%) were from patients with COPD and were included in the study. Median age was 73 [65-79] years. Twenty (83%) of which were male. FEV1 was 1.23 [0.81-1.40]L, 45 [36-52]%. Fourteen (64%) had severe to very severe airflow obstruction. Eleven (55%) had distension. Eleven (46%) patients had long-term oxygen therapy. Sixteen (67%) were treated with inhaled corticosteroids (ICS) with a median dose of beclomethasone equivalent of 500 [500-650] µg/day. Median tobacco exposure was 33 [30-48] pack-year. Eight (33%) had a history of alcohol dependence. Eight (33%) patients had frequent exacerbations. Four (17%) patients had previous history of colonization by another NTM. MC was more commonly identified in patients admitted for an acute exacerbation (n:18, 78%). Symptoms were: dyspnea (n:20, 87%), cough (n:16, 70%), phlegm production (n:14, 61%). Co-pathogens were identified in 11 (46%) patients of which the more frequent were another NTM (n:5, 45%) and Pseudomonas aeruginosa (n:3, 27%). CT data was available for 22 (92%) patients. Most frequent abnormalities were: emphysema (n:19, 86%), bronchiectasis (n:16, 73%), nodules (n:13, 73%), micro-nodules (n:8, 36%). Seven (29%) patients met ATS criteria for infection, 4 (17%) were treated. The median survival time following first isolation of MC was 5.3 years with no significant difference between patients with MC disease and those with colonization: 5.1 vs. 4.1 years respectively (p:0.16). CONCLUSION: In our cohort, MC isolation in COPD patients does not correlate with specific clinical or radiological features. Emphysema and bronchiectasis were frequently identified. There was no association between the diagnosis of an NTM disease and survival.
Author Block: R. Lukaszewicz1, K. El Husseini2, S. Skalli3, L. Thiberville2, A. Cuvelier2, M. Patout1; 1Respiratory, thoracic oncology, intensive care unit, Rouen University Hospital, Rouen, France, 2Respiratory, thoracic oncology, intensive care unit, Rouen University Hospital, ROUEN, France, 3Microbiology, Rouen University Hospital, ROUEN, France.
BACKGROUND: Non-tuberculous mycobacteria (NTM) have a detrimental impact on the course of COPD. Mycobacterium chimaera (MC) has been identified recently. Data on COPD patients with MC are sparse. The aim of this study was to describe the clinical, radiological presentation and the outcome associated with MC isolation in COPD patients. METHODS: We performed a retrospective observational study. We included all patients with COPD and with at least one respiratory bacteriological sample positive for MC between 2009 and 2016. Patients data were recorded from electronic medical record. American Thoracic Society diagnostic criteria were used to distinguish disease from colonization. RESULTS: From the 123 MC isolates of our center, 24 (20%) were from patients with COPD and were included in the study. Median age was 73 [65-79] years. Twenty (83%) of which were male. FEV1 was 1.23 [0.81-1.40]L, 45 [36-52]%. Fourteen (64%) had severe to very severe airflow obstruction. Eleven (55%) had distension. Eleven (46%) patients had long-term oxygen therapy. Sixteen (67%) were treated with inhaled corticosteroids (ICS) with a median dose of beclomethasone equivalent of 500 [500-650] µg/day. Median tobacco exposure was 33 [30-48] pack-year. Eight (33%) had a history of alcohol dependence. Eight (33%) patients had frequent exacerbations. Four (17%) patients had previous history of colonization by another NTM. MC was more commonly identified in patients admitted for an acute exacerbation (n:18, 78%). Symptoms were: dyspnea (n:20, 87%), cough (n:16, 70%), phlegm production (n:14, 61%). Co-pathogens were identified in 11 (46%) patients of which the more frequent were another NTM (n:5, 45%) and Pseudomonas aeruginosa (n:3, 27%). CT data was available for 22 (92%) patients. Most frequent abnormalities were: emphysema (n:19, 86%), bronchiectasis (n:16, 73%), nodules (n:13, 73%), micro-nodules (n:8, 36%). Seven (29%) patients met ATS criteria for infection, 4 (17%) were treated. The median survival time following first isolation of MC was 5.3 years with no significant difference between patients with MC disease and those with colonization: 5.1 vs. 4.1 years respectively (p:0.16). CONCLUSION: In our cohort, MC isolation in COPD patients does not correlate with specific clinical or radiological features. Emphysema and bronchiectasis were frequently identified. There was no association between the diagnosis of an NTM disease and survival.
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