TY - JOUR
T1 - Epidemiology and management of nontuberculous mycobacterial disease in people with cystic fibrosis, the Netherlands
AU - Zomer, Domenique
AU - van Ingen, Jakko
AU - Hofland, Regina
AU - Akkerman, O. W.
AU - Altenburg, J.
AU - Bakker, M.
AU - Bannier, M. A. G. E.
AU - Conemans, L. H.
AU - Gulmans, V. A. M.
AU - Heijerman, H. G. M.
AU - Hoek, R. A. S.
AU - Janssens, H. M.
AU - van der Meer, R.
AU - Merkus, P. J. F. M.
AU - Noordhoek, J. J.
AU - Nuijsink, M.
AU - Terheggen-Lagro, S. W. J.
AU - van der Vaart, H.
AU - Dutch CF Registry Steering group
AU - de Winter-de Groot, K. M.
N1 - Funding Information: We thank all people with CF who consented to the Dutch CF Registry. We also thank all CF centers for participating in this project, with special thanks to the people who filled in the survey and/or imported the data for the Dutch CF Registry. No external funding was received for this study. Publisher Copyright: © 2022
PY - 2022
Y1 - 2022
N2 - Background: Nontuberculous mycobacteria (NTM) are opportunistic, difficult to treat pathogens. With increasing prevalence of NTM infections in people with cystic fibrosis (pwCF) and the improved life expectancy, the burden is expected to grow. Methods: We assessed the epidemiology and management of NTM isolation and disease in pwCF in the Netherlands using a survey and retrospective, case-controlled data from the Dutch CF Registry. We determined the isolation prevalence, treatment and outcomes from 2013-2019. Results: NTM isolation prevalence increased from 1.0% to 3.6% (2013-2019). This was a single NTM isolation in 53.7% of the adults and 60.0% of the children. M. abscessus and M. avium complex (MAC) were most frequent (47.1 and 30.9%). Of the treated pwCF, 48.5% attained culture conversion of M. abscessus; 54.5% for MAC. Children with an NTM isolation showed more infections with S. maltophilia and/or A. fumigatus (p < 0.001) compared to controls. In the year prior to NTM isolation, children in the NTM group had a lower mean FEV1% predicted (81.5 ± 16.7 vs. 88.6 ± 15.3, p = 0.024), while adults in the NTM group had more IV antibiotic days compared to controls (60 vs. 17, p = 0.047). In the following years, FEV1% predicted declined faster in pwCF with NTM than the control group (children: -3.8% vs. -1.6%, p = 0.023; adults: -0.7% and 0.4%, ns). Conclusions: The isolation prevalence of 3.6%, poor treatment outcomes and associated lung function decline emphasize that NTM pulmonary disease (NTM-PD) is a significant health issue among pwCF in the Netherlands. Its prevention and treatment require increased attention.
AB - Background: Nontuberculous mycobacteria (NTM) are opportunistic, difficult to treat pathogens. With increasing prevalence of NTM infections in people with cystic fibrosis (pwCF) and the improved life expectancy, the burden is expected to grow. Methods: We assessed the epidemiology and management of NTM isolation and disease in pwCF in the Netherlands using a survey and retrospective, case-controlled data from the Dutch CF Registry. We determined the isolation prevalence, treatment and outcomes from 2013-2019. Results: NTM isolation prevalence increased from 1.0% to 3.6% (2013-2019). This was a single NTM isolation in 53.7% of the adults and 60.0% of the children. M. abscessus and M. avium complex (MAC) were most frequent (47.1 and 30.9%). Of the treated pwCF, 48.5% attained culture conversion of M. abscessus; 54.5% for MAC. Children with an NTM isolation showed more infections with S. maltophilia and/or A. fumigatus (p < 0.001) compared to controls. In the year prior to NTM isolation, children in the NTM group had a lower mean FEV1% predicted (81.5 ± 16.7 vs. 88.6 ± 15.3, p = 0.024), while adults in the NTM group had more IV antibiotic days compared to controls (60 vs. 17, p = 0.047). In the following years, FEV1% predicted declined faster in pwCF with NTM than the control group (children: -3.8% vs. -1.6%, p = 0.023; adults: -0.7% and 0.4%, ns). Conclusions: The isolation prevalence of 3.6%, poor treatment outcomes and associated lung function decline emphasize that NTM pulmonary disease (NTM-PD) is a significant health issue among pwCF in the Netherlands. Its prevention and treatment require increased attention.
KW - Cystic fibrosis
KW - Management
KW - Nontuberculous mycobacterial disease
KW - Outcomes
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=85142773884&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcf.2022.10.009
DO - https://doi.org/10.1016/j.jcf.2022.10.009
M3 - Article
C2 - 36347785
SN - 1569-1993
JO - Journal of cystic fibrosis
JF - Journal of cystic fibrosis
ER -