Surgery in nontuberculous mycobacteria pulmonary disease

作者：Mimi Lu, Dominic A. Fitzgerald, Jonathan Saul Karpelowsky, Hiran C. Selvadurai, Chetan Pandit, Paul David Robinson, Ben J. Marais · 发表于：Breathe · 年份：2018 · DOI：10.1183/20734735.027218 · 被引用次数：26 · 研究领域：Mycobacterium research and diagnosis、Lung Cancer Diagnosis and Treatment、Tracheal and airway disorders

Medical treatment of pulmonary nontuberculous mycobacteria (NTM) disease has highly variable outcomes. Despite the use of multiple antibiotics, sputum clearance is often difficult to achieve, especially in cases with macrolide resistant NTM infection. Immunocompromised patients and those with structural lung disease are at increased risk, although occurrence in immunocompetent patients without structural lung disease is well recognised. Most pulmonary NTM disease involvesMycobacterium aviumcomplex (MAC), but with enhanced identification multiple species have now been recognised as opportunistic pathogens. The observed increase in NTM disease, especially infection with multidrug-resistantMycobacterium abscessuscomplex, is probably multifactorial. Surgery has been used as adjuvant treatment in patients with 1) focal disease that can be removed or 2) bothersome symptoms despite medical treatment that can be ameliorated. Early post-surgical mortality is low, but long-term morbidity and mortality are highly dependent on the degree of lung involvement and the residual lung function, the potency of medical treatment and the type of surgical intervention. In conjunction with antibiotic therapy, reported post-surgical sputum clearance was excellent, although publication bias should be considered. Bronchopleural fistulae were problematic, especially in pneumonectomy cases. Study results support the use of minimal resection surgery, in a carefully selected subgroup of patients with foca...