Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study
Abstract Purpose Lung transplant recipients are at increased risk for acquiring nontuberculous mycobacteria (NTM), but the clinical significance of NTM isolation, particularly among patients not meeting guideline-endorsed diagnostic criteria for NTM pulmonary disease, is unclear. Methods A case-cont...
Gespeichert in:
| Veröffentlicht in: | American journal of health-system pharmacy 2022-02, Vol.79 (5), p.338-345 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 345 |
|---|---|
| container_issue | 5 |
| container_start_page | 338 |
| container_title | American journal of health-system pharmacy |
| container_volume | 79 |
| creator | Grimes, Razelle Cherrier, Lauren Nasar, Aasya Nailor, Michael D Walia, Rajat Goodlet, Kellie J |
| description | Abstract
Purpose
Lung transplant recipients are at increased risk for acquiring nontuberculous mycobacteria (NTM), but the clinical significance of NTM isolation, particularly among patients not meeting guideline-endorsed diagnostic criteria for NTM pulmonary disease, is unclear.
Methods
A case-control study of lung transplant recipients culture-positive for NTM at a large transplant center during a 7-year period (2013-2019) was performed.
Results
Twenty-nine cases were matched 1:2 to non-NTM controls. The median time to NTM isolation was 10.7 months post transplant. Only 34.5% of all cases, and half of treated cases, met diagnostic criteria for NTM pulmonary infection. All-cause mortality at 12 months was numerically higher among NTM cases versus controls (20.7% vs 8.6%, P = 0.169); however, no deaths were attributed to NTM. No increase in the 12-month rate of acute rejection was observed (27.6% vs 36.2%, P = 0.477). Recent augmented immunosuppression was associated with increased odds of NTM isolation, while azithromycin prophylaxis was associated with reduced odds of NTM isolation and was not associated with macrolide resistance. Both adverse events and actual or potential drug-drug interactions occurred in more than 90% of treated cases; these events included ocular toxicity, hearing loss, and supratherapeutic calcineurin inhibitor concentrations. Eight of the 14 treated cases (57.1%) required early antibiotic discontinuation due to adverse events or drug-drug interactions.
Conclusion
Among lung transplant recipients, most patients with NTM isolation did not meet guideline criteria for infection and had outcomes similar to non‒NTM-infected patients, which may reflect transient lung colonization by NTM rather than true disease. As adverse events are common with NTM therapy, limiting unnecessary antibiotic treatment represents an area for future antimicrobial stewardship efforts. |
| doi_str_mv | 10.1093/ajhp/zxab389 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_ajhp_zxab389</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ajhp/zxab389</oup_id><sourcerecordid>10.1093/ajhp/zxab389</sourcerecordid><originalsourceid>FETCH-LOGICAL-c323t-598f4606d984703cd0f64c919be6c429a59055ffd5a063705ca1bc3232bbd8d03</originalsourceid><addsrcrecordid>eNp9kD1PwzAQhi0EoqWwMSNvLISe7SSN2aqKL6lSF5gj23FoqiSO_AGUn8CvxlULI8vdOzz36vQgdEnglgBnU7FZD9OvTyFZwY_QmGQsSygHOI4ZZjyhUNAROnNuA0BoAfkpGrE0ZymhdIy-V8Er02mHTY170_sgtVWhNcHhbquMFMpr2wjcONMK35gei870b7gNcXgreje0ovfYatUMje69u8Nz3Amv1rrCSjidqFhrTYs_Gr-OXMxu0Mo37xorszbWY-dDtT1HJ7Vonb447Al6fbh_WTwly9Xj82K-TBSjzCcZL-o0h7ziRToDpiqo81RxwqXOVUq5yDhkWV1XmYCczSBTgsjdKZWyKipgE3Sz71XxEWd1XQ626YTdlgTKndJyp7Q8KI341R4fgux09Qf_OozA9R4wYfi_6gf86oWY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><creator>Grimes, Razelle ; Cherrier, Lauren ; Nasar, Aasya ; Nailor, Michael D ; Walia, Rajat ; Goodlet, Kellie J</creator><creatorcontrib>Grimes, Razelle ; Cherrier, Lauren ; Nasar, Aasya ; Nailor, Michael D ; Walia, Rajat ; Goodlet, Kellie J</creatorcontrib><description>Abstract
Purpose
Lung transplant recipients are at increased risk for acquiring nontuberculous mycobacteria (NTM), but the clinical significance of NTM isolation, particularly among patients not meeting guideline-endorsed diagnostic criteria for NTM pulmonary disease, is unclear.
Methods
A case-control study of lung transplant recipients culture-positive for NTM at a large transplant center during a 7-year period (2013-2019) was performed.
Results
Twenty-nine cases were matched 1:2 to non-NTM controls. The median time to NTM isolation was 10.7 months post transplant. Only 34.5% of all cases, and half of treated cases, met diagnostic criteria for NTM pulmonary infection. All-cause mortality at 12 months was numerically higher among NTM cases versus controls (20.7% vs 8.6%, P = 0.169); however, no deaths were attributed to NTM. No increase in the 12-month rate of acute rejection was observed (27.6% vs 36.2%, P = 0.477). Recent augmented immunosuppression was associated with increased odds of NTM isolation, while azithromycin prophylaxis was associated with reduced odds of NTM isolation and was not associated with macrolide resistance. Both adverse events and actual or potential drug-drug interactions occurred in more than 90% of treated cases; these events included ocular toxicity, hearing loss, and supratherapeutic calcineurin inhibitor concentrations. Eight of the 14 treated cases (57.1%) required early antibiotic discontinuation due to adverse events or drug-drug interactions.
Conclusion
Among lung transplant recipients, most patients with NTM isolation did not meet guideline criteria for infection and had outcomes similar to non‒NTM-infected patients, which may reflect transient lung colonization by NTM rather than true disease. As adverse events are common with NTM therapy, limiting unnecessary antibiotic treatment represents an area for future antimicrobial stewardship efforts.</description><identifier>ISSN: 1079-2082</identifier><identifier>EISSN: 1535-2900</identifier><identifier>DOI: 10.1093/ajhp/zxab389</identifier><identifier>PMID: 34634122</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Case-Control Studies ; Drug Resistance, Bacterial ; Humans ; Lung ; Macrolides ; Nontuberculous Mycobacteria ; Retrospective Studies ; Transplant Recipients</subject><ispartof>American journal of health-system pharmacy, 2022-02, Vol.79 (5), p.338-345</ispartof><rights>American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2021</rights><rights>American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c323t-598f4606d984703cd0f64c919be6c429a59055ffd5a063705ca1bc3232bbd8d03</citedby><cites>FETCH-LOGICAL-c323t-598f4606d984703cd0f64c919be6c429a59055ffd5a063705ca1bc3232bbd8d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34634122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grimes, Razelle</creatorcontrib><creatorcontrib>Cherrier, Lauren</creatorcontrib><creatorcontrib>Nasar, Aasya</creatorcontrib><creatorcontrib>Nailor, Michael D</creatorcontrib><creatorcontrib>Walia, Rajat</creatorcontrib><creatorcontrib>Goodlet, Kellie J</creatorcontrib><title>Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study</title><title>American journal of health-system pharmacy</title><addtitle>Am J Health Syst Pharm</addtitle><description>Abstract
Purpose
Lung transplant recipients are at increased risk for acquiring nontuberculous mycobacteria (NTM), but the clinical significance of NTM isolation, particularly among patients not meeting guideline-endorsed diagnostic criteria for NTM pulmonary disease, is unclear.
Methods
A case-control study of lung transplant recipients culture-positive for NTM at a large transplant center during a 7-year period (2013-2019) was performed.
Results
Twenty-nine cases were matched 1:2 to non-NTM controls. The median time to NTM isolation was 10.7 months post transplant. Only 34.5% of all cases, and half of treated cases, met diagnostic criteria for NTM pulmonary infection. All-cause mortality at 12 months was numerically higher among NTM cases versus controls (20.7% vs 8.6%, P = 0.169); however, no deaths were attributed to NTM. No increase in the 12-month rate of acute rejection was observed (27.6% vs 36.2%, P = 0.477). Recent augmented immunosuppression was associated with increased odds of NTM isolation, while azithromycin prophylaxis was associated with reduced odds of NTM isolation and was not associated with macrolide resistance. Both adverse events and actual or potential drug-drug interactions occurred in more than 90% of treated cases; these events included ocular toxicity, hearing loss, and supratherapeutic calcineurin inhibitor concentrations. Eight of the 14 treated cases (57.1%) required early antibiotic discontinuation due to adverse events or drug-drug interactions.
Conclusion
Among lung transplant recipients, most patients with NTM isolation did not meet guideline criteria for infection and had outcomes similar to non‒NTM-infected patients, which may reflect transient lung colonization by NTM rather than true disease. As adverse events are common with NTM therapy, limiting unnecessary antibiotic treatment represents an area for future antimicrobial stewardship efforts.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Case-Control Studies</subject><subject>Drug Resistance, Bacterial</subject><subject>Humans</subject><subject>Lung</subject><subject>Macrolides</subject><subject>Nontuberculous Mycobacteria</subject><subject>Retrospective Studies</subject><subject>Transplant Recipients</subject><issn>1079-2082</issn><issn>1535-2900</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0EoqWwMSNvLISe7SSN2aqKL6lSF5gj23FoqiSO_AGUn8CvxlULI8vdOzz36vQgdEnglgBnU7FZD9OvTyFZwY_QmGQsSygHOI4ZZjyhUNAROnNuA0BoAfkpGrE0ZymhdIy-V8Er02mHTY170_sgtVWhNcHhbquMFMpr2wjcONMK35gei870b7gNcXgreje0ovfYatUMje69u8Nz3Amv1rrCSjidqFhrTYs_Gr-OXMxu0Mo37xorszbWY-dDtT1HJ7Vonb447Al6fbh_WTwly9Xj82K-TBSjzCcZL-o0h7ziRToDpiqo81RxwqXOVUq5yDhkWV1XmYCczSBTgsjdKZWyKipgE3Sz71XxEWd1XQ626YTdlgTKndJyp7Q8KI341R4fgux09Qf_OozA9R4wYfi_6gf86oWY</recordid><startdate>20220218</startdate><enddate>20220218</enddate><creator>Grimes, Razelle</creator><creator>Cherrier, Lauren</creator><creator>Nasar, Aasya</creator><creator>Nailor, Michael D</creator><creator>Walia, Rajat</creator><creator>Goodlet, Kellie J</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20220218</creationdate><title>Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study</title><author>Grimes, Razelle ; Cherrier, Lauren ; Nasar, Aasya ; Nailor, Michael D ; Walia, Rajat ; Goodlet, Kellie J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c323t-598f4606d984703cd0f64c919be6c429a59055ffd5a063705ca1bc3232bbd8d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Case-Control Studies</topic><topic>Drug Resistance, Bacterial</topic><topic>Humans</topic><topic>Lung</topic><topic>Macrolides</topic><topic>Nontuberculous Mycobacteria</topic><topic>Retrospective Studies</topic><topic>Transplant Recipients</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grimes, Razelle</creatorcontrib><creatorcontrib>Cherrier, Lauren</creatorcontrib><creatorcontrib>Nasar, Aasya</creatorcontrib><creatorcontrib>Nailor, Michael D</creatorcontrib><creatorcontrib>Walia, Rajat</creatorcontrib><creatorcontrib>Goodlet, Kellie J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>American journal of health-system pharmacy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grimes, Razelle</au><au>Cherrier, Lauren</au><au>Nasar, Aasya</au><au>Nailor, Michael D</au><au>Walia, Rajat</au><au>Goodlet, Kellie J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study</atitle><jtitle>American journal of health-system pharmacy</jtitle><addtitle>Am J Health Syst Pharm</addtitle><date>2022-02-18</date><risdate>2022</risdate><volume>79</volume><issue>5</issue><spage>338</spage><epage>345</epage><pages>338-345</pages><issn>1079-2082</issn><eissn>1535-2900</eissn><abstract>Abstract
Purpose
Lung transplant recipients are at increased risk for acquiring nontuberculous mycobacteria (NTM), but the clinical significance of NTM isolation, particularly among patients not meeting guideline-endorsed diagnostic criteria for NTM pulmonary disease, is unclear.
Methods
A case-control study of lung transplant recipients culture-positive for NTM at a large transplant center during a 7-year period (2013-2019) was performed.
Results
Twenty-nine cases were matched 1:2 to non-NTM controls. The median time to NTM isolation was 10.7 months post transplant. Only 34.5% of all cases, and half of treated cases, met diagnostic criteria for NTM pulmonary infection. All-cause mortality at 12 months was numerically higher among NTM cases versus controls (20.7% vs 8.6%, P = 0.169); however, no deaths were attributed to NTM. No increase in the 12-month rate of acute rejection was observed (27.6% vs 36.2%, P = 0.477). Recent augmented immunosuppression was associated with increased odds of NTM isolation, while azithromycin prophylaxis was associated with reduced odds of NTM isolation and was not associated with macrolide resistance. Both adverse events and actual or potential drug-drug interactions occurred in more than 90% of treated cases; these events included ocular toxicity, hearing loss, and supratherapeutic calcineurin inhibitor concentrations. Eight of the 14 treated cases (57.1%) required early antibiotic discontinuation due to adverse events or drug-drug interactions.
Conclusion
Among lung transplant recipients, most patients with NTM isolation did not meet guideline criteria for infection and had outcomes similar to non‒NTM-infected patients, which may reflect transient lung colonization by NTM rather than true disease. As adverse events are common with NTM therapy, limiting unnecessary antibiotic treatment represents an area for future antimicrobial stewardship efforts.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>34634122</pmid><doi>10.1093/ajhp/zxab389</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1079-2082 |
| ispartof | American journal of health-system pharmacy, 2022-02, Vol.79 (5), p.338-345 |
| issn | 1079-2082 1535-2900 |
| language | eng |
| recordid | cdi_crossref_primary_10_1093_ajhp_zxab389 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE |
| subjects | Anti-Bacterial Agents - therapeutic use Case-Control Studies Drug Resistance, Bacterial Humans Lung Macrolides Nontuberculous Mycobacteria Retrospective Studies Transplant Recipients |
| title | Outcomes of nontuberculous mycobacteria isolation among lung transplant recipients: A matched case-control with retrospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T13%3A12%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-oup_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Outcomes%20of%20nontuberculous%20mycobacteria%20isolation%20among%20lung%20transplant%20recipients:%20A%20matched%20case-control%20with%20retrospective%20cohort%20study&rft.jtitle=American%20journal%20of%20health-system%20pharmacy&rft.au=Grimes,%20Razelle&rft.date=2022-02-18&rft.volume=79&rft.issue=5&rft.spage=338&rft.epage=345&rft.pages=338-345&rft.issn=1079-2082&rft.eissn=1535-2900&rft_id=info:doi/10.1093/ajhp/zxab389&rft_dat=%3Coup_cross%3E10.1093/ajhp/zxab389%3C/oup_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/34634122&rft_oup_id=10.1093/ajhp/zxab389&rfr_iscdi=true |