Retrospective analysis of nontuberculous mycobacterial disease treatment at the Golnik University clinic during the period 2009 - 2015

Netuberkulozne mikobakterije lahko pri ljudeh povzročajo klinično pomembne okužbe. Najpogosteje se pojavljajo štiri oblike mikobakterioz. Večina bolnikov ima pljučno obliko, možni so še limfadenitis, mikobakterioza kože, kosti in mehkih tkiv ter mikobakterioza s prizadetostjo več različnih organskih sistemov hkrati. Diagnozo bolezni se postavi na podlagi mikrobioloških, kliničnih in radioloških podatkov. Identifikacija mikobakterij je pomembna za določitev ustrezne kombinacije zdravil, zdravljenje pa je dolgotrajno. Namen naloge je pregled populacije, ki je imela med letoma 2009 in 2015 na Kliniki Golnik diagnosticirano okužbo z netuberkuloznimi mikobakterijami ter analiza obravnav bolnikov, ki so bili zaradi netuberkulozne mikobakterioze zdravljeni. V raziskavo smo vključili bolnike s celotno obravnavo netuberkulozne mikobakterioze na Kliniki Golnik. Netuberkulozne mikobakterije so izolirali 420 bolnikom. Zdravljenih je bilo 42/420 bolnikov – 36 bolnikov je imelo pljučno in 6 bolnikov izvenpljučno mikobakteriozo. Dejavniki tveganj, ki so bili pogosto prisotni pri zdravljenih bolnikih, so bili moški spol (59,5 %), starejši odrasli (povprečna starost 59,5 let), kajenje (69,1%) in prisotnost vsaj ene pljučne bolezni (54,8 %). Najpogostejši simptomi ob začetku zdravljenja so bili kašelj (88,8 %), dispneja (77,8 %) in hujšanje (55,5 %) pri pljučnih mikobakteriozah in bolečine v predelu okužbe (50 %) pri izvenpljučnih netuberkuloznih mikobakteriozah. Zabeležili smo 11 različnih povzročiteljev netuberkuloznih mikobakterioz, najpogosteje so bile zdravljene okužbe povzročene z M. avium, M. kansasii, M. intracellulare in M. xenopi. Za zdravljenje je bila največkrat predpisana kombinacija etambutola, rifampicina in klaritromicina. Do sprememb zdravljenja je prišlo pri 19/42 (45,2 %) bolnikov. Najpogosteje je bil v spremembi vključen etambutol (11/19 bolnikov). Pri 12/19 bolnikov so bili vzrok za spremembo zdravljenja neželeni učinki. Zdravljenje je uspešno zaključilo 14/36 (38,9 %) bolnikov s pljučno in vseh 6 bolnikov z izvenpljučno mikobakteriozo, skupaj 20/42 (47,6 %) bolnikov. Do ponovne izolacije mikobakterij v kužninah je prišlo pri 11/42 (26,2 %) bolnikov, večina izmed teh je zdravljenje zaključilo predčasno (8/11 bolnikov, 72,7 %). Za ponovno zdravljenje smo se odločili pri 4/11 bolnikov. Zdravljenja so v povprečju trajala 351 dni. Zaključena zdravljenja so trajala 443 dni, 283 dni so trajala zdravljenja zaključena predčasno iz kateregakoli razloga in 185 dni zdravljenja, ki so bila predčasno zaključena zaradi neželenih učinkov zdravil.Nontuberculous mycobacterial disease in humans is clinically relevant infections. There are four types of nontuberculous mycobacterial disease. Most patients have lung disease, some of them have lymphatic disease, skin, bones and soft tissues disease or disseminated disease. Diagnosis of nontuberculous mycobacterial disease is based on microbiological, clinical and radiological data. Identification of mycobacteria is essential, as it influences the choice of antimicrobial agents. Treatment of nontuberculous mycobacterial disease is long lasting. The purpose of the master thesis was to review the population that was diagnosed with nontuberculous mycobacteria at the Golnik University clinic between years 2009 and 2015 and analysis of the treatment of patients who were treated for it. The study included only the patients who were treated exclusively at the Golnik University clinic. Nontuberculous mycobacterias were isolated from 420 patients. 42/420 patients were treated for nontuberculous mycobacterial disease – 36 patients had lung disease and 6 patients extrapulmonary disease. The risk factors that were frequently present in the treated patients were male sex (59.5%), average age 59.5 years, smoking (69.1% of patients) and the presence of at least one pulmonary diagnosis (54.8%). In patients with lung disease the most common symptoms at the beginning of the treatment were cough (88.8%), dyspnea (77.8%) and weight loss (55.5%), while in patients with extrapulmonary disease the typical symptom was a pain in the part of the body where infection had first occurred (50%). We identified 11 different pathogens as causes of nontuberculous mycobacterial disease, the most common of them being M. avium, M. kansasii, M. intracellulare and M. xenopi. The combination of ethambutol, rifampicin and clarithromycin was most often prescribed for the treatment. Changes in treatment occurred in 19/42 (45.2%) patients, most often due to ethambutol (11/19 patients). In 12/19 patients side effects were the reason to change the treatment.14/36 (38,9%) patients with lung disease and all 6 patients with extrapulmonary disease, 20/42 (47,6%) patients in total, successfully completed the treatment. Relapse occurred in 11/42 (26,2%) patients, especially in patients who completed the treatment prematurely (8/11 b 72,7%). 4/11 patients were treated again after relapse. On average, treatments lasted 351 days, successfully completed treatments 443 days, treatment failures 283 days and treatment failures because of side effects 185 days