• Yunjoo Im, Na Young Hwang, Kyunga Kim, Hojoong Kim, KwonO JungOJDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea., and Byung Woo Jhun.
• Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
• Chest. 2022 May 1; 161 (5): 119212001192-1200.

BackgroundLimited data are available regarding when to start treatment after a diagnosis of nontuberculous mycobacteria-pulmonary disease (NTM-PD) or regarding how achieving culture conversion affects NTM-PD outcomes.Research QuestionDoes the time between diagnosis and antibiotic initiation influence culture conversion or all-cause mortality in NTM-PD, and is there any association between achieving culture conversion after antibiotics and reduced all-cause mortality?Study Design And MethodsWe evaluated 712 patients who received antibiotics for 6 or more months after diagnosis of NTM-PD between July 1997 and December 2013. Data on the waiting period, defined as the interval between diagnosis and treatment initiation, and on outcomes such as culture conversion by 6 months or death were collected. Factors associated with outcomes were analyzed after adjusting for disease severity, using the BMI, age, cavity, erythrocyte sedimentation rate (ESR), and sex (BACES) system.ResultsThirty-eight percent of study patients had mild disease, 48% had moderate disease, and 14% had severe disease. The median waiting period without antibiotics among all patients was 4.8 (interquartile range, 1.3-20.8) months. After treatment initiation, 479 (67%) patients achieved culture conversion within 6 months, and 135 (19%) patients died. In univariable and multivariable models adjusted for BACES severity, no association between the waiting period and 6-month culture conversion or death was identified. However, 6-month culture conversion demonstrated a significant negative correlation with death (crude hazard ratio [HR], 0.46, 95% CI, 0.33-0.65; adjusted HR, 0.51, 95% CI, 0.35-0.74). In the subgroup treated for more than 12 months, 12-month culture conversion was also associated with reduced death (adjusted HR, 0.51; 95% CI, 0.33-0.78).InterpretationIt may be reasonable to start antibiotics according to the "watchful waiting" strategy for NTM-PD, but given the survival benefits, achieving culture conversion is an important goal for patients in need of treatment.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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