1625. Impact of Adjunctive Lung Resection for Treatment of M. abscessus complex Pneumonia on Quality of Life (QOL) at 12 Months
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • QOL_IDSA_POSTER_091813_SUBMIT.pdf (203.2 kB)
  • Background: We evaluated whether lung resection added to combination antibiotic therapy for M. abscessuscomplex pneumonia improves QOL.

    Methods: Saint George’s Respiratory Questionnaire (SGRQ) and chest CT data were prospectively collected at baseline and 12 months from 42 patients referred for individualized antibiotics ± surgery.  The minimal clinically important difference (MCID) in SGRQ Total score was 4.  A chest radiologist graded severity of 7 CT findings by lobe. 

    Results: Patients were mean age 66±11 years, 83% female, 95% white, 45% former smokers, 7% had cystic fibrosis, and all had nodules and bronchiectasis on CT.  Enrollment sputum AFB cultures were positive in 81%.  Patients received a mean of 11±2 months of oral therapies, 4±3 months IV therapies, and 6±5 months nebulized therapies.  14 (33%) had lung resection (lobectomy, lingulectomy).  Surgical patients were less likely AFB culture positive at baseline (64% vs. 89%, p=0.09), received a longer course of IV antibiotics (5±4 months vs. 4±3 months, p=0.07), had more severe baseline bronchiectasis (p=0.04), atelectasis (p<0.01), mucus plugs (p<0.01), and less severe cavitary disease (p=0.06).  Mean baseline SGRQ Total score was 35±19, and was similar in surgical and non-surgical patients (p=0.45).  Total score improved 8±13 points overall (p<0.01), with greater improvement in surgical patients (17±12 (p<0.01) vs. 3±12 (p=0.09), (p-difference <0.01).  93% of surgical patients had improvement in Total score >MCID versus 39% of non-surgical patients (p<0.01).  36% of non-surgical patients had worsening >MCID.  Improvement >MCID was associated with greater baseline FEV1 %predicted (73±16 vs. 64±17, p=0.09) and greater baseline severity of mucus plugs (0.04).  The adjusted OR for improvement in Total score >MCID was 19 (95%CI 1, 341).  Among 24 patients with follow-up CT data, only surgical patients had improvements in bronchiectasis, small nodules, consolidation, atelectasis, and mucus plugs (p≤0.01 each).  Only small nodules improved in un-resected lobes (p=0.02).  Change in CT scores did not correlate with change in SGRQ Total score.

    Conclusion: Lung resection was associated with improvement in QOL.  Surgery removed focal disease, and allowed antibiotics to address nodules in un-resected lobes.

    Christopher Czaja1,2, Adrah Levin1, Christian Cox1,2, Charles Daley1,2, John Newell3 and Gary Cott1,2, (1)National Jewish Health, Denver, CO, (2)University of Colorado School of Medicine, Aurora, CO, (3)University of Iowa, Iowa City, IA

    Disclosures:

    C. Czaja, Insmed: Liposomal amikacin for NTM: Investigator, I am a subI and have not received compensation. The Insmed study is not related to the abstract.

    A. Levin, None

    C. Cox, None

    C. Daley, Insmed: Liposomal Amikacin for NTM: Investigator, Grant recipient

    J. Newell, None

    G. Cott, None

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