Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors

Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. All adults in Denmark with at least one NTM-positive pulmonary specimen during...

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Vydáno v:	American journal of respiratory and critical care medicine Ročník 181; číslo 5; s. 514 - 521
Hlavní autoři:	Andrejak, Claire, Thomsen, Vibeke O, Johansen, Isik S, Riis, Anders, Benfield, Thomas L, Duhaut, Pierre, Sorensen, Henrik T, Lescure, Francois-Xavier, Thomsen, Reimar W
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	New York, NY Am Thoracic Soc 01.03.2010 American Thoracic Society
Témata:	Adolescent Adult Age Age Factors Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiovascular Diseases - complications Cardiovascular Diseases - microbiology Comorbidity Denmark - epidemiology Disease Epidemiology Female Health care Humans Incidence Intensive care medicine Male Medical prognosis Medical sciences Middle Aged Mortality Mycobacterium Infections, Nontuberculous - complications Mycobacterium Infections, Nontuberculous - epidemiology Mycobacterium Infections, Nontuberculous - microbiology Mycobacterium Infections, Nontuberculous - mortality Nontuberculous Mycobacteria Patients Pneumology Prognosis Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Sex Factors Survival Analysis Tuberculosis, Pulmonary - complications Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - microbiology Tuberculosis, Pulmonary - mortality Young Adult Denmark Europe epidemiological study Lung disease atypical mycobacteria Intensive care Prognosis Respiratory disease Mortality Epidemiology Lung mycobacteriosis Resuscitation Incidence
ISSN:	1073-449X, 1535-4970, 1535-4970
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Abstract	Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.
AbstractList	Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis.RATIONALEFew population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis.To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors.OBJECTIVESTo examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors.All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization.METHODSAll adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization.We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death.MEASUREMENTS AND MAIN RESULTSWe calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death.NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.CONCLUSIONSNTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi. Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi. Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.
Author	Andrejak, Claire Riis, Anders Lescure, Francois-Xavier Duhaut, Pierre Benfield, Thomas L Thomsen, Reimar W Thomsen, Vibeke O Sorensen, Henrik T Johansen, Isik S
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Keywords	epidemiological study Lung disease atypical mycobacteria Intensive care Prognosis Respiratory disease Mortality Epidemiology Lung mycobacteriosis Resuscitation Incidence
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Snippet	Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. To examine NTM pulmonary... Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. To examine NTM pulmonary... Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis.RATIONALEFew population-based...
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SubjectTerms	Adolescent Adult Age Age Factors Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiovascular Diseases - complications Cardiovascular Diseases - microbiology Comorbidity Denmark - epidemiology Disease Epidemiology Female Health care Humans Incidence Intensive care medicine Male Medical prognosis Medical sciences Middle Aged Mortality Mycobacterium Infections, Nontuberculous - complications Mycobacterium Infections, Nontuberculous - epidemiology Mycobacterium Infections, Nontuberculous - microbiology Mycobacterium Infections, Nontuberculous - mortality Nontuberculous Mycobacteria Patients Pneumology Prognosis Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Sex Factors Survival Analysis Tuberculosis, Pulmonary - complications Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - microbiology Tuberculosis, Pulmonary - mortality Young Adult
Title	Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors
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