Abstract Rationale Sparse published nationwide data from India, very few global longitudinal studies are available regarding treatment outcomes of nontuberculous mycobacterial (NTM) disease. Methods In this prospective observational study (2021-2025), culture-confirmed NTM-pulmonary disease NTM-PD and extrapulmonary-NTM disease EP-NTM patients ≥12 years of age, irrespective of their HIV status, after obtaining informed consent, were included. Patients with concurrent active TB were excluded. NTM species/subspecies identification was performed using line probe assay and validated by whole-genome sequencing. Baseline laboratory testing included serum vitamins D3, B12. Counselling on treatment duration, adverse events, and compliance was done before species-specific treatment initiation as per ATS/IDSA/ERS/ESCMID 2020 guidelines. Clinical, radiological, microbiological, and adverse-event monitoring was conducted during follow-up every 1-2 months. Free treatment was provided from project funds; telephonic or home visit follow-up was done if hospital access was limited. Slowly growing mycobacteria received macrolides with ethambutol and rifampicin; severe disease or rapidly growing mycobacteria (RGM) required intensification with parenteral amikacin and linezolid/clofazimine. Results One hundred and fifty-five patients (mean age 44.4SD:15.2 years; 9259.4% males; NTM-PD 123, EP-NTM 32) were initiated on treatment. Key risk factors for NTM-PD included prior pulmonary TB 96.8%, malnutrition 47.1%, bronchiectasis 23.8%, and COPD 19.3%. Most common species identified: M.avium complex (44/155;28.4%), M.abscessus complex 44/155;28.4%, and M.kansasii 23/155;14.8%. Mean time from symptom onset to seeking healthcare was 92.1 days SD:44.1 and interval from first healthcare contact to species/subspecies-level diagnosis was 120 SD:50 days; overall diagnostic delay was 212.4 days SD:38. Of the 155, 137 88.4% patients completed treatment, 9 5.8% died, and another 9 5.8% were lost to follow-up. Treatment completion, death, and loss-to-follow-up were 110/123 89.4%, 5/123 4.1%, and 8/123 6.5% for NTM-PD versus 27/32 84.4%, 4/32 12.5%, and 1/32 3.1% for EP-NTM, respectively P = 0.15. Mean time-to-culture conversion in NTM-PD was 94.3SD:42.6 days. Three-drug regimen was most frequently used (3 vs 4 vs 5 drugs: 127/155 82.0%, 27/155 17.4%, 1/155 0.7%), with four-drug use administered in severe NTM-PD or RGM. Mean treatment duration was 550.5SD:94.3 days for NTM-PD and 237.3SD:115.5 days for EP-NTM. Common adverse effects included: gastrointestinal disturbance 68.4%; hepatotoxicity 14.8%; tinnitus 1.9%; optic neuritis 1.3%; thrombocytopenia 1.3%. Tinnitus (n = 2; amikacin alone; amikacin plus linezolid) and optic neuritis (ethambutol plus linezolid) resolved quickly after drug-discontinuation. One patient with tigecycline-induced thrombocytopenia died from other comorbidities; linezolid-induced thrombocytopenia in another patient reversed after drug-discontinuation. Conclusions Early diagnosis up to species/subspecies-level (where indicated), structured follow-up, judicious use of guideline-based regimen facilitate good treatment outcomes. This abstract is funded by: Indian Council of Medical Research (ICMR), New Delhi, India,Department of Health Research, Ministry of Health & Family Welfare, Government of India (Project file no: no.5/8/5/41/ITRC/2018/ECD-I)
Sharma et al. (Fri,) studied this question.
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