Prevalence and risk factors for chronic co-infection in pulmonary Mycobacterium avium complex disease.
Prevalence and risk factors for chronic co-infection in pulmonary Mycobacterium avium complex disease.
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DOI：
10.1136/bmjresp-2014-000050
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发表时间：
2014
影响因子：
4.1
通讯作者：
Mishima M
中科院分区：
文献类型：
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作者：
Fujita K;Ito Y;Hirai T;Kubo T;Togashi K;Ichiyama S;Mishima M
肺鸟分枝杆菌复合群（MAC）病患者常合并多种病原微生物感染。本研究旨在确定肺MAC疾病患者中非MAC病原体合并感染的患病率以及与合并感染相关的危险因素。我们回顾性分析了2001年1月至2013年5月期间在京都大学医院就诊的275例肺MAC患者的患者特征、微生物学结果和胸部CT结果。我们将慢性病原性合并感染定义为从两次以上访视（至少间隔3个月）采集的痰液样本中分离出非MAC病原体。 参与者主要是女性（74.5%），感染了M。鸟类占75.6%。在124例患者（45.1%）中观察到与任何病原体的慢性合并感染。甲氧西林敏感金黄色葡萄球菌（MSSA; n=64），铜绿假单胞菌（n=35）和曲霉菌（n=18）是最常见的病原体。调整因素为慢性阻塞性肺疾病（COPD; OR=4.2，95%CI 1.6 - 13.1）和肺M。细胞内疾病（OR=2.2，95% CI 1.1 - 4.4）慢性合并感染; COPD（OR=4.2，95% CI 2.1 - 31.4），MAC疾病持续时间长（OR=2.2，95% CI 1.2 - 4.4）和结节（OR=3.5，95% CI 1.2 - 13.2）慢性MSSA合并感染; COPD（OR=7.5，95% CI 2.1 - 31.4）和下叶受累（OR=9.9，95% CI 2.0 - 90.6）;全身性皮质类固醇的使用（OR=7.1，95% CI 1.2 - 50.9）和肺M。在慢性曲霉菌属合并感染中，胞内疾病（OR=4.0，95% CI 1.1至14.5）。患有肺MAC疾病的患者经常与病原微生物如MSSA、铜绿假单胞菌和曲霉菌慢性合并感染。慢性合并感染的危险因素为COPD和肺结核。胞内疾病
Patients with pulmonary Mycobacterium avium complex (MAC) disease are often co-infected with various pathogenic microorganisms. This study aimed to determine the prevalence of co-infection with non-MAC pathogens and the risk factors associated with co-infection in patients with pulmonary MAC disease. We retrospectively reviewed the patient characteristics, microbiological results and chest CT findings in 275 patients with pulmonary MAC who visited the Kyoto University Hospital from January 2001 to May 2013. We defined chronic pathogenic co-infection as the isolation of non-MAC pathogens from sputum samples taken on more than two visits that occurred at least 3 months apart. The participants were predominantly female (74.5%) and infected with M. avium (75.6%). Chronic co-infection with any pathogen was observed in 124 patients (45.1%). Methicillin-sensitive Staphylococcus aureus (MSSA; n=64), Pseudomonas aeruginosa (n=35) and Aspergillus spp (n=18) were the most prevalent pathogens. The adjusted factors were chronic obstructive pulmonary disease (COPD; OR=4.2, 95% CI 1.6 to 13.1) and pulmonary M. intracellulare disease (OR=2.2, 95% CI 1.1 to 4.4) in chronic co-infections; COPD (OR=4.2, 95% CI 2.1 to 31.4), long duration of MAC disease (OR=2.2, 95% CI 1.2 to 4.4) and nodules (OR=3.5, 95% CI 1.2 to 13.2) in chronic MSSA co-infection; COPD (OR=7.5, 95% CI 2.1 to 31.4) and lower lobe involvement (OR=9.9, 95% CI 2.0 to 90.6) in chronic P. aeruginosa co-infection; and use of systemic corticosteroids (OR=7.1, 95% CI 1.2 to 50.9) and pulmonary M. intracellulare disease (OR=4.0, 95% CI 1.1 to 14.5) in chronic Aspergillus spp co-infection. Patients with pulmonary MAC disease frequently had chronic co-infections with pathogenic microorganisms such as MSSA, P. aeruginosa and Aspergillus. The risk factors for chronic co-infection were COPD and pulmonary M. intracellulare disease.