Treatment failure of nontuberculosis pulmonary disease after adjunctive surgical resection

Surgical resection with antibiotic therapy has been demonstrated to provide better clinical outcomes in nontuberculous mycobacteria-pulmonary disease (NTM-PD). However, little is known about the outcomes of adjuvant surgical resection difference between Mycobacterium avium complex (MAC)-PD and Mycobacterium Abscessus (MAB)-PD. We investigated the clinical differences and risk factors associated with treatment failure after adjunctive surgical resection. MAC-PD and MAB-PD patients who received adjunctive pulmonary resection to antibiotic treatment between January 2009 and September 2019 were included. Patients who had previous history of lung resection or were confirmed to be other than NTM-PD were excluded. During median follow-up of 57 months [interquartile range (IQR) 42 – 94 months], 138 NTM-PD patients, 100 (72.5%) MAC-PD and 38 (28%) MAB-PD were included. MAC-PD had more patients who had been previously treated for NTM-PD (MAC-PD 60% vs MAB-PD 39%, p=0.031). Culture conversion after surgery was achieved in 109 (97%), 78 (88%) in MAC-PD and 31 (86%) in MAB-PD (p=0.817). However, 35 (22%) had recurred, 24 (27%) from MAC-PD and 11 (31%) from MAB-PD (p=0.686), after median 38 months (IQR 19-62 months) after surgery. MAB-PD patients [Hazard ratio (HR) 2.5, 95% confidence interval (CI) 1.03-6.25, p=0.042] and patients who had culture conversion after 4 months of treatment [HR 5.26, 95% CI 1.79-16.7), p=0.003] were at a higher risk of recur. MAB-PD patients and those who achieve culture conversion more than 4 months after treatment initiation should be closely approached and monitored after adjuvant surgical resection of NTM-PD.