Comparison of clinical features of pulmonary infections with Mycobacterium intracellulare and Mycobacterium abscessus in tuberculosis intensive care unit / 中华临床感染病杂志

ABSTRACT

Objective To compare the clinical features of pulmonary infections with Mycobacterium intracellulare and Mycobacterium abscessus in the tuberculosis intensive care unit (ICU).Methods Clinical data of 74 patients with non-tuberculous mycobacterial pulmonary infection (NTM) admitted in tuberculosis ICU of Hangzhou Red Cross Hospital from January 2012 to May 2017 were retrospectively analyzed.There were 54 patients infected with Mycobacterial abscesses, 16 patients with Mycobacterial intracellular, 2 patients with Mycobacterium avium and 2 patients with Mycobacterium kansasii.The clinical features, imaging manifestations, treatment and prognosis of patients with Mycobacterial intracellular and Mycobacterial abscesses lung infections were compared.SPSS 21.0 software was used for statistical analysis.Survival curve analysis was performed using GraphPad Prism V 5.01.Results Among 74 patients with NTM lung disease , the infection rate of Mycobacterium abscessus was 72.87%(54/74), and the infection rate of Mycobacterium intracellular was 21.62%( 16/74 ).The age of patients with Mycobacterium intracellularis pulmonary disease was younger and the length of ICU stay was shorter than those of patients with Mycobacterium abscessus (t＝－2.729 and －6.150, P＜0.05 or ＜0.01).There was no significant difference in the gender distribution and APACHE Ⅱ scores between the two groups ( both P＞0.05).The proportion of patients with chronic obstructive pulmonary disease ( COPD) in Mycobacterium intracellularis group was significantly lower and the proportion of patients with bronchiectasis was significantly higher than those in Mycobacterial abscesses group (χ2＝3.902, P＜0.05; χ2＝23.888, P＜0.01).The proportion of patients complicated with stroke sequelae , Parkinson's disease and other central nervous system diseases ( χ2＝14.872, P＜0.01) and diabetes (χ2＝3.902, P＜0.05) in Mycobacterial abscess group was significantly higher, and that of hemoptysis was significantly lower (χ2＝9.717, P＜0.01) than those in Mycobacterium intracellularis group.Respiratory failure (93.75%) and septic shock (6.25%) were the main reasons of ICU admission for patients with Mycobacterium intracellularis lung disease; while respiratory failure (90.74%), heart failure (11.11%) and renal failure (1.85%) were main reasons of ICU admission for patients with Mycobacterial abscesses; there were no significant differences in the causes of ICU admission between the two groups ( all P＞0.05).The proportion of NTM isolated from patients with Mycobacterial intracellular lung disease, prior to mechanical ventilation was significantly higher than that of patients with Mycobacterial abscess ( χ2＝30.366, P ＜0.01 ).In imaging, the proportion of bronchiectasis in Mycobacterium intracellularis lung disease group was significantly higher than that in Mycobacterial abscesses lung disease group (χ2＝23.888, P＜0.01).There was no significant difference in the 28-day mortality rate between the two groups (χ2＝3.244, P＞0.05), while the survival rate in patients with Mycobacterium intracellularis lung disease within 120 days was significantly higher than that in patients with Mycobacterial abscesses lung disease (χ2＝12.780, P＜0.01).Conclusion When critically ill patients are positive for acid-fast staining, the ICU physician should consider the possibility of NTM lung disease.For severe patients with long-term mechanical ventilation , Mycobacterium abscessus infection should be considered first.