Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium avium complex pulmonary disease: a systemic review and meta-analysis

<b>Background:</b> Macrolide is a key drug in the treatment of <i>Mycobacterium avium</i> complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little data in clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MAC-PD). <b>Methods:</b> We performed a systemic review and meta-analysis of published studies reporting clinical characteristics and treatment outcomes of patients with MR-MAC-PD. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. <b>Results:</b> Five studies (four retrospective and one prospective) in three countries, comprising 214 patients were identified through database search. Around 66% were women, and 53% had the fibrocavitary form. Sputum culture conversion rate was 20% (95% confidence interval [CI], 12–32%), and the one-year all-cause mortality rate was 12% (95% CI, 6–23%). There was no significant difference in treatment outcomes between nodular bronchiectatic and fibrocavitary type. <b>Conclusions:</b> The treatment outcomes of MR-MAC-PD were poor. Because macrolide resistance can develop during macrolide monotherapy, two-drug combination of macrolide/quinolone or macrolide/rifamycin, and even standard multidrug regimens, new treatment modalities such as bedaquiline or amikacin inhalation should be investigated.