1180. Improvement in Quality of Life During the First 6 Months of Therapy for Mycobacterium abscessus Complex Pulmonary Infection
Session: Poster Abstract Session: Mycobacteria Other Than Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1

Background:  Mycobacterium abscessus complex is an increasingly important cause of chronic pulmonary infection.  Treatment involves prolonged combination antibiotic regimens.  Because cure rates are low, other treatment goals, including improvement in quality of life (QOL), may be appropriate.

Methods: Patients referred to National Jewish Health for treatment of M. abscessus complex (N=23) or M. chelonae (N=1) pulmonary infection were enrolled in a prospective cohort study.  The Saint George's Respiratory Questionnaire (SGRQ) was administered at baseline, 3, and 6 months.  Treatment side effects were recorded at 3 and 6 months. Statistical analyses utilized paired t-tests in SAS® version 9.1.

Results: Patients were 75% female, 92% white, with median age 68 years. All had lung nodules and bronchiectasis, and 45% had lung cavities.  17% were smear positive.  42% had M. avium-intracellulare and 29% Pseudomonas co-infection.   Antibiotics during the first 6 months generally included a macrolide (100%, 92% azithromycin), either imipenem (54%) or cefoxitin (46%), intravenous or nebulized amikacin (83%), ± a fluoroquinolone (63%). 26% had lung resection.  SGRQ scores improved at 3 months (Symptoms: mean difference -11, p=0.01; Activity: -8, p=0.02, Impacts: -8, p=0.02; Total: -9, p<0.01) and stabilized between 3 and 6 months (Symptoms: +0.7, p=0.84; Activity: +3, p=0.42; Impacts: +2, p=0.54; Total: +2, p=0.51) (Figure).  The greatest improvements occurred at 3 months in patients with baseline SGRQ scores above the mean (Total if baseline≥38: -13, p<0.01).  58% and 23% reported antibiotic side effects at 3 and 6 months, respectively, and similar percentages said antibiotics “interfered” with their life.

Conclusion: Patients treated aggressively for M. abscessus complex pulmonary infection had clinically important improvements in QOL, most notable in the first 3 months.  Improvements coincided with initial intravenous antibiotic therapy, and were greatest in patients with worse baseline QOL.  Antibiotics were intrusive, and side effects common.  Airway hygiene and treatment of co-infections likely contributed to improvements. The SGRQ is a potential tool to identify patients who benefit from treatment and to monitor treatment response.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Christopher Czaja1,2, Adrah Levin1, Charles Daley1,2, John Newell1,2 and Gary Cott1,2, (1)National Jewish Health, Denver, CO, (2)University of Colorado School of Medicine, Aurora, CO

Disclosures:

C. Czaja, None

A. Levin, None

C. Daley, None

J. Newell, None

G. Cott, None

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