The Timing of Intravenous Antibiotic Regimens and Clinical Outcomes of Mycobacterium abscessus complex Lung Diseases: a retrospective multicenter cohort study

Abstract Background The treatment of Mycobacterium abscessus complex lung diseases (MABC-LD) requires a combination of multiple antibiotics, including at least 1 initial intravenous (IV) agent. However, the importance of early IV antibiotics use, as recommended in the guidelines for MABC-LD treatment, remains unknown. Methods A retrospective observational study was conducted in 6 hospitals in Taiwan. Patients who were diagnosed with and received treatments for MABC-LD from January 2007 to April 2021 were included, but patients with treatment durations of shorter than 14 days were excluded. Treatment outcome was defined as modified microbiological cure of MABC-LD. Results Thirty-four of the 89 enrolled patients (38.2%) received IV antibiotics in the treatment course. The median time to IV initiation was 1 day (IQR: 1–49), and 24 (70.6%) of them received IV agents within 4 weeks, defined as early use. Forty-two (47.2%) patients achieved modified microbiological cure. In the multivariable logistic analysis, early IV antibiotics use was an independent factor associated with modified microbiological cure (adjusted odds ratio [aOR] 8.58, 95% CI: 2.31–31.86), whereas high radiological score (aOR 0.83, 95% CI: 0.70–0.98) and long treatment duration (aOR 0.998, 95% CI: 0.996–0.999) demonstrated negative association. Conclusions In the present study, early use of IV effective antibiotic was prescribed in a low percentage (27%) for MABC-LD. By contrast, early IV antibiotics use was correlated with higher microbiological cure than were late or non-use. Greater adherence to the guideline may improve the clinical outcome in treating MABC-LD. Future larger and prospective studies are needed to validate the association.