Comparison of clinical characteristics and prognostic factors between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease

doi:10.19982/j.issn.1000-6621.20250411

Abstract

Abstract:

Objective: To compare the clinical characteristics and drug resistance profiles between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease (MAB-PD), and to analyze the prognostic factors influencing treatment outcomes. Methods: A total of 123 patients diagnosed with MAB-PD at Beijing Chest Hospital, Capital Medical University, from January 1, 2021, to May 31, 2023, were enrolled and divided into an elderly group (48 patients, age ≥65 years) and a non-elderly group (75 patients, age <65 years). Clinical data, drug susceptibility testing results, and treatment outcomes were collected. The clinical features of the two groups were compared, and prognostic factors associated with treatment outcomes were analyzed. Results: The incidence of cavitary lesions was significantly higher in elderly MAB-PD patients (41.7% (20/48)) compared to non-elderly patients (24.0% (18/75)). The proportion of patients with pleural adhesion was also significantly greater in the elderly group (66.7% (32/48)) than in the non-elderly group (46.7% (35/75)) (χ²=4.279, P=0.039; χ²=4.721, P=0.030, respectively). Multivariate logistic analysis identified age ≥65 years (OR=2.532, 95%CI: 1.048-6.120), BMI<18.5 kg/m² (OR=4.379, 95%CI: 1.758-10.905), and the presence of pleural adhesion (OR=3.566, 95%CI: 1.420-8.955) as independent risk factors for treatment failure. Conclusion: Elderly patients with MAB-PD are more likely to present with pulmonary cavities and pleural adhesions. Advanced age, low BMI, and pleural adhesion are significant risk factors for treatment failure in MAB-PD patients. Individualized management strategies should be considered for elderly patients, those with malnutrition, and those exhibiting pleural adhesions on imaging.

Key words: Aged, Mycobacterium infections, Atypical bacterial forms, Drug resistance, Treatment outcomes

CLC Number:

R563

Shang Yuanyuan, Nie Wenjuan, Chu Naihui. Comparison of clinical characteristics and prognostic factors between elderly and non-elderly patients with Mycobacterium abscessus pulmonary disease[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 106-112. doi: 10.19982/j.issn.1000-6621.20250411

Figures/Tables 3

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR值	95%CI值
性别(女性)	―0.038	0.486	0.006	0.938	0.963	0.371~2.496
气促	―0.094	0.551	0.029	0.864	0.910	0.309~2.679
BMI<18.5kg/m²	1.477	0.466	10.064	0.002	4.379	1.758~10.905
空洞	0.145	0.475	0.094	0.760	1.156	0.456~2.936
年龄≥65岁	0.929	0.450	4.260	0.039	2.532	1.048~6.120
胸膜粘连	1.271	0.470	7.325	0.007	3.566	1.420~8.955

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特征	老年MAB-PD患者(48例)				非老年MAB-PD患者(75例)				χ²值		P值
特征	例数		发生率(%)		例数		发生率(%)		χ²值		P值
性别^a									0.396		0.529
男性	16		33.3		21		28.0
女性	32		66.7		54		72.0
临床表现
咳嗽	39		81.3		61		81.3		0.000		0.991
气促	13		27.1		10		13.3		3.640		0.056
咳痰	37		77.1		56		74.7		0.093		0.761
咯血	10		20.8		20		26.7		0.540		0.462
发热	10		20.8		20		26.7		0.540		0.462
吸烟	8		16.7		9		12.0		0.535		0.464
饮酒	3		6.2		5		6.7		0.008		0.927
体质量指数(kg/m²)^a										0.096	0.757
<18.5		16		33.3		23		30.7
≥18.5		32		66.7		52		69.3
合并恶性肿瘤		9		18.8		7		9.3		2.293	0.130
既往抗结核治疗		24		50.0		42		56.0		0.424	0.515
糖皮质激素/免疫抑制剂治疗		5		10.4		6		8.0		-^b	0.749^b
既往药物治疗史
克林霉素		8		16.7		14		18.7		0.080	0.778
阿奇霉素		5		10.4		2		2.7		-^b	0.109^b
阿米卡星		9		18.8		13		17.3		0.040	0.841
亚胺培南		0		0.0		2		2.7		-^b	0.520^b
头孢西丁		3		6.2		3		4.0		-^b	0.677^b
利奈唑胺		6		12.5		5		6.7		-^b	0.336^b
左氧氟沙星		10		20.8		16		21.3		0.004	0.947
莫西沙星		4		8.3		9		12.0		0.416	0.519
支气管扩张病史		19		39.6		38		50.7		1.446	0.229
胸部CT影像
结节		38		79.2		54		72.0		0.797	0.372
空洞		20		41.7		18		24.0		4.279	0.039
树芽征		17		35.4		34		45.3		1.186	0.276
囊状支气管扩张		32		66.7		50		66.7		0.000	1.000
胸膜粘连		32		66.7		35		46.7		4.721	0.030

药物名称	老年MAB-PD患者(17例)		非老年MAB-PD患者(31例)		χ²值	P值
药物名称	耐药例数	耐药率(%)	耐药例数	耐药率(%)	χ²值	P值
阿米卡星	3	17.6	1	3.2	-^a	0.121^a
头孢西丁	11	64.7	20	64.5	0.000	0.990
环丙沙星	12	70.6	28	90.3	-^a	0.112^a
克拉霉素	8	47.1	8	25.8	2.231	0.135
亚胺培南	15	88.2	30	96.8	-^a	0.283^a
利奈唑胺	7	41.2	17	54.8	0.82	0.365
米诺环素	16	94.1	29	93.5	-^a	1.000^a
莫西沙星	13	76.5	26	83.9	-^a	0.701^a
妥布霉素	15	88.2	28	90.3	-^a	1.000^a
甲氧苄啶/磺胺甲噁唑	13	76.5	25	80.6	-^a	0.727^a
多西环素	17	100.0	30	96.8	-^a	1.000^a