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A Statewide Analysis of Rhode Island Pulmonary Mycobacterium Avium Complex Cultures with Clinical Correlation
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A2610 - A Statewide Analysis of Rhode Island Pulmonary Mycobacterium Avium Complex Cultures with Clinical Correlation
Author Block: D. Gutman1, T. Bennett2, K. Chapin3, E. King2, M. L. Stanchina1, E. Carter1; 1Pulmonary, Critical Care and Sleep Medicine, Alpert School of Medicine-Brown Univ, Providence, RI, United States, 2Rhode Island Department of Health State Health Laboratories, Providence, RI, United States, 3Pathology, Alpert School of Medicine-Brown Univ, Providence, RI, United States.
Rationale: The spectrum of pulmonary infection associated with Mycobacterium avium complex (MAC) is broad, making clinical assessment and treatment decisions complex. Population based assessment of laboratory data has been performed in few specific US regions. Further, the correlation of culture data with clinically relevant disease in a large, non-referral population is unclear. We aimed to review all MAC culture positive results in Rhode Island (RI) to determine the clinical cascade from laboratory data to treatment of patients, with subsequent outcomes.
Methods: We conducted a population based retrospective review of all RI patients with a MAC isolate between 2013 and 2016 (n=235) through the RI State Health Laboratories, which receives and processes all positive mycobacterial cultures for the state. Detailed chart review was performed where available for assessment of symptoms, imaging results, treatment regimens and outcomes.
Results: 235 patients had a respiratory specimen that grew MAC on culture. 157 of these met ATS/IDSA microbiological criteria for disease (≥2 sputum or one bronchoscopically obtained sample). The annualized prevalence of pulmonary MAC-disease is estimated to be 4.5/100,000 cases per year for RI. Detailed chart review data was available for 62 patients with MAC-disease by microbiology. Mean follow up time was 26.5 months. Imaging revealed cavitary disease (11, 18%), bronchiectatic/nodular disease (48, 77%), and normal findings (3, 5%). Treatment was pursued in 35 patients (56%). Treatment was deferred in the rest either due to an assessment that the patient lacked significant symptoms or had co-morbidities increasing risk-benefit ratio. 25 (71%) of the cases initiating treatment were considered adequately treated by their physician although culture conversion was confirmed only in 13 (27%). 10 (28%) patients had clinical evidence of persistent MAC-disease with or without repeated testing of cultures. In the 27 patients in whom treatment was deferred, 5 died due to unrelated causes and 2 were lost to follow up, while the rest had no clinical evidence of disease progression within the study time period.
Conclusion: The annualized prevalence rate of MAC culture positive patients in RI is similar to rates previously documented in non-referral settings in other states. In nearly half of patients in whom a diagnosis of MAC was made, treatment was not pursued due to perceived lack of benefit; however, outcomes did not suffer. We speculate that understanding the innate immunity and natural history of this cohort will better elucidate the positive outcomes noted.
Author Block: D. Gutman1, T. Bennett2, K. Chapin3, E. King2, M. L. Stanchina1, E. Carter1; 1Pulmonary, Critical Care and Sleep Medicine, Alpert School of Medicine-Brown Univ, Providence, RI, United States, 2Rhode Island Department of Health State Health Laboratories, Providence, RI, United States, 3Pathology, Alpert School of Medicine-Brown Univ, Providence, RI, United States.
Rationale: The spectrum of pulmonary infection associated with Mycobacterium avium complex (MAC) is broad, making clinical assessment and treatment decisions complex. Population based assessment of laboratory data has been performed in few specific US regions. Further, the correlation of culture data with clinically relevant disease in a large, non-referral population is unclear. We aimed to review all MAC culture positive results in Rhode Island (RI) to determine the clinical cascade from laboratory data to treatment of patients, with subsequent outcomes.
Methods: We conducted a population based retrospective review of all RI patients with a MAC isolate between 2013 and 2016 (n=235) through the RI State Health Laboratories, which receives and processes all positive mycobacterial cultures for the state. Detailed chart review was performed where available for assessment of symptoms, imaging results, treatment regimens and outcomes.
Results: 235 patients had a respiratory specimen that grew MAC on culture. 157 of these met ATS/IDSA microbiological criteria for disease (≥2 sputum or one bronchoscopically obtained sample). The annualized prevalence of pulmonary MAC-disease is estimated to be 4.5/100,000 cases per year for RI. Detailed chart review data was available for 62 patients with MAC-disease by microbiology. Mean follow up time was 26.5 months. Imaging revealed cavitary disease (11, 18%), bronchiectatic/nodular disease (48, 77%), and normal findings (3, 5%). Treatment was pursued in 35 patients (56%). Treatment was deferred in the rest either due to an assessment that the patient lacked significant symptoms or had co-morbidities increasing risk-benefit ratio. 25 (71%) of the cases initiating treatment were considered adequately treated by their physician although culture conversion was confirmed only in 13 (27%). 10 (28%) patients had clinical evidence of persistent MAC-disease with or without repeated testing of cultures. In the 27 patients in whom treatment was deferred, 5 died due to unrelated causes and 2 were lost to follow up, while the rest had no clinical evidence of disease progression within the study time period.
Conclusion: The annualized prevalence rate of MAC culture positive patients in RI is similar to rates previously documented in non-referral settings in other states. In nearly half of patients in whom a diagnosis of MAC was made, treatment was not pursued due to perceived lack of benefit; however, outcomes did not suffer. We speculate that understanding the innate immunity and natural history of this cohort will better elucidate the positive outcomes noted.
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