Epidemiology of Nontuberculous Mycobacterial Infections and Associated Chronic Macrolide Use among Persons with Cystic Fibrosis.

Binder AM, Adjemian J, Olivier KN, Prevots DR.

Source

NIAID, LCID, Bethesda, Maryland, United States.

Abstract

Rationale: Persons with cystic fibrosis (CF) are at high risk of nontuberculous mycobacterial (NTM) infection, with treatment requiring prolonged multi-drug regimens that include macrolides. While macrolides, specifically azithromycin, are used in the management of CF patients with chronic Pseudomonas, macrolide-resistant NTM infections are of growing concern. We sought to evaluate the relationship between macrolide use and NTM infections among CF patients. Objective: To evaluate the relationship between chronic macrolide use and NTM infection among CF patients included in the 2011 CF Patient Registry (CFPR). Main Results: The 2011 CFPR included 27,112 patients; 5,403 (20%) were cultured for mycobacteria in 2010-2011 and met all inclusion criteria. Of these, 191 (4%) were NTM-positive in 2011 only (incident cases), while 5,212 (96%) were NTM-negative in both 2010 and 2011 (controls). Among the cases, 122 (64%) were culture-positive for Mycobacterium avium complex (MAC) and 69 (36%) for M. abscessus. Azithromycin use in 2010 was less frequently reported among MAC cases (57%; OR=0.7, p< 0.05) and M. abscessus cases (51%; OR=0.5, p< 0.01) than in controls (66%). Among adolescents and adults, patients with the greatest number of years on chronic macrolides were the least likely to develop incident NTM in 2011 (p<0 .01="" abscessus="" azithromycin="" be="" because="" cf.="" chronic="" conclusions:="" considered="" either="" for="" from="" had="" have="" however="" in="" incident="" infections="" lead="" less="" likely="" m.="" mac="" macrolide="" may="" monotherapy="" ntm="" or="" p="" past="" patients="" persons="" resistance="" routine="" screening="" should="" the="" to="" treatment="" were="" with="" year.="">