关键词: 分枝杆菌,非典型性, 感染, 肺, 治疗应用

Abstract:

Objective: To assess the efficacy of different antibiotics combined on Mycobacterium abscessus subspecies abscessus pulmonary disease (M.abscessus-PD) and analyze the influencing factors of treatment outcomes for 6 months. Methods: Sixty-six patients in Beijing Chest Hospital, Capital Medical University diagnosed with M.abscessus-PD were enro1led prospectively from January 1st, 2016 to October 1st, 2022. Clinical information of the patients were collected, including gender, age, body mass index, clinical manifestations, history of past illness and anti-tuberculosis treatment, imaging examinations, laboratory examinations and medications. The factors influencing treatment outcomes of M.abscessus-PD for 6 months among different therapicregimens was compared. Results: After 6 months of treatment, 32 (48.5%) achieved sputum culture conversion and 34 (51.5%) didn’t among the 66 patients. The result shows that the 6-month sputum culture conversion rate of azithromycin users (57.4%, 27/47) was higher than clarithromycin users (26.3%, 5/19), with statistically significant (χ²=5.250,P=0.022). In 24 cases (36.4%, 24/66) treated with imipenem, 17 (70.8%, 17/24) achieved 6 months sputum culture conversion, which was higher than that of non-imipenem (35.7%, 15/42), with statistically significant difference (χ²=7.542, P=0.006). The efficacy of multidrug therapy regimen showed that macrolide combined with amikacin, imipenem, linezolid and clofazimine achieved 68.4% (13/19) culture conversion rate after 6 months. Multivariate analysis shows that patients treated with macrolide combined with imipenem were more likely to achieve sputum culture conversion within 6 months (OR (95%CI)=0.229 (0.077-0.676)). Conclusion: In the initial stage of treatment, at least 4 weeks of injection use (amikacin and imipenem), and the combination of macrolides with amikacin, clofazimine, and linezolid in the continued treatment, may have good curative effect on M.abscessus-PD.

Key words: Mycobacteria, atypical, Infection, Lung, Therapeutic uses