- Email: [email protected]
109 Mycobacterium abscessus infection in cystic fibrosis, our clinical experience
Poster Sessions / Journal of Cystic Fibrosis 16S1 (2017) S63–S174
annually in spontaneously expectorating individuals with a stable clinical course. In 2014 we introduced a new selective agar medium; RGM, designed for the isolation of rapidly-growing species of NTM. The objective of this study was to retrospectively assess the impact of introducing this new medium compared with standard AFB culture. Methods: Every sputum sample submitted from a patient with CF was digested with sputasol and 10 μl cultured onto RGM without decontamination of samples. Cough swabs were cultured directly onto RGM medium. Plates were incubated at 30°C for 10 days. Isolates were confirmed by rpoB/ sodA/hsp65 sequence cluster analysis and VNTR typing. Standard AFB culture was performed only when specifically requested using the Mycobacterial Growth Indicator Tube (MGIT) and culture on LowensteinJensen medium. We retrospectively analyzed 15 months of data to assess the rates of detection of NTM using these two approaches. Results: Every respiratory sample submitted from 625 patients with CF was cultured using RGM medium without decontamination of samples. This allowed the detection of NTM in 56 patients. Over the same time period, requests for formal AFB culture were submitted for 235 patients with CF and NTM were recovered from 21 patients. Conclusion: NTM were detected from more than twice as many patients (56 vs. 22) by routine use of RGM rather than relying on annual submission of specimens for formal AFB culture. Using RGM medium, NTM was first detected from 15 patients using cough swabs, whereas AFB culture is not recommended for these samples. RGM is a highly selective agar that can be incorporated into routine use for all CF respiratory samples for the isolation of NTM. 109 Mycobacterium abscessus infection in cystic fibrosis, our clinical experience I. González Márquez1, M.E. Quintana-Gallego1, M. Domínguez Begines1, M.J. Moreno Valera1, L. Carrasco Hernández1, M.P. Gaboli1, I. Delgado-Pecellín1. 1Hospital Universitario Virgen del Rocío, CF Unit, Sevilla, Spain
S93
Introduction: Nontuberculous mycobacteria (NTM) are emerging pathogens in CF patients. Aim: To assess NTM prevalence and associated features in a adult CF Centre. Methods: Clinical records from adult CF patients regularly followed between 2013 and 2016 were reviewed. Sputum microbiology, age, concomitant medication, diagnostic criteria, treatment regimens were evaluated. Results: From 51 patients five patients (16–44years) had NTM detected in sputum analysis resulting in a 9.8% prevalence rate. Two patients had Mycobacterium abcessus (M. abcessus) and 3 patients had Mycobacterium avium complex (MAC). All had Aspergillus spp. in sputum microbiology analyses and 3 had chronic PSAE infection. Only the patients with M. abcessus were taking azithromycin previously. 3 patients were using inhaled corticosteroids. A 20%fall of the predicted FEV1 was recorded in one patient, the others maintained their usual values. Four patients meet IDSA/ ATS criteria for NTM pulmonary disease. The two patients with MAC who underwent treatment (ethambutol, rifampicin and clarithromycin), achieved eradication in 12months. One patient relapse two months after ending treatment, maintaining treatment ever since. An intensive regimen (cefotaxime, amikacin and clarithromycin) was applied for 4 weeks to the patients with M. abcessus. The one that underwent maintenance treatment with ciprofloxacin, clarithromycin, doxicycline and inhaled amikacin, achieved eradication in 18 months. The other patient with M. abcessus is currently on maintenance treatment with ciprofloxacin, clarithromycin, doxicycline and inhaled tobramycin for 19 months. Conclusions: Although until 2013 no NMT were detected in our centre, in recent years our prevalence rate (9.8%) is in accordance with the global trend of increasing NTM. No correlation can be made between the presence of NTM and possible risk factors in such a small population. However, our eradication rate (50%) reinforce the difficulty in treating these patients. 111 Non-tuberculous mycobacteria in patients with cystic fibrosis: detection and isolation from respiratory samples. Results of a cross-sectional study
Objectives: Mycobacterium abscessus (M.A.) is a nontuberculous mycobacteria (NTM) frequently isolated in cystic fibrosis (CF). Chronic infection with M.A. is associated with lung function decrease. Our aim is to analyze infection incidence in CF patients and their characteristics, evaluate the treatment used and its repercussion on lung function (FEV1). Methods: Retrospective study of CF patients with M.A infection in a CF reference unit in the last 10 years. Microbiological, genetic, radiological and functional tests were analyzed six months before diagnosis, at diagnosis and after treatment. Results: Ten cases with M.A. infection were identified. Characteristics: 6 (60%) males, 4 (40%) deltaF508 heterozygous mutation, age 26.1 ± 11.97 years. Regarding chronic colonization: 6 patients (60%) colonized by Pseudomonas aeruginosa and 4 (40%) by Staphylococcus aureus. At CT, most common radiological findings were bronchiectasis in all, nodules in 30%. Most common symptoms were: Cough and secretion increase in 5 (50%), hemoptysis in 3 (30%), fever in 2 (20%). Acute episode were treated with carbapenems, amikacin and macrolides for 4–8 weeks, with some cases requiring moxifloxacin and linezolid in addition. 3 patients (30%) received maintenance treatment for up to 18 months. Only 3 patients received macrolide treatment before diagnosis. 70% eradication rate, 3 patients diagnosed in the last months with negative cultures after treatment. No differences were found between FEV1 mean 6 months prior to diagnosis (FEV1 74.2%) and diagnosis (FEV1 73%) or between FEV1 at diagnosis and after treatment (FEV1 77.8%). Conclusion: In our series, M.A. infection was eradicated in most patients, some requiring several cycles or maintenance therapy. Clinical features of CF patients do not allow identification of factors that favor infection. M.A. should be considered in diagnostic and therapeutic algorithm of CF patients and be ruled out in clinical or functional decrease.
B. Fabrizzi1, N. Caporelli1, N. Cirilli1, A.G. Lazarte1, F. Masseria1, M. Cipolli1. 1 Ospedali Riuniti Ancona, Fibrosi Cistica, Ancona, Italy
110 Non-tuberculous mycobacteria in a Portuguese cystic fibrosis centre
M.J. Moreno Valera1, M.E. Quintana-Gallego2, M. Domínguez Begines1, I. González Márquez1, M.P. Gaboli1, L. Carrasco Hernández2, I. Delgado-Pecellín1. 1Hospital Universitario Virgen del Rocío, Unidad de Neumología Pediátrica, Seville, Spain; 2Hospital Universitario Virgen del Rocío, Servicio de Neumología, Seville, Spain
F. Ferro1, C. Lopes1, P. Azevedo1, C. Bárbara1. 1Centro Especializado de Fibrose Quística, Serviço de Pneumologia, Hospital de Santa Maria, CHLN, Lisbon, Portugal
Objectives: Epidemiological studies show a rising prevalence of NTM (Non-tuberculous mycobacteria) positive cultures in respiratory samples from CF patients ( pts) over the last four decades. Active infection can damage lungs causing pulmonary disease in CF individuals. The aim of this study is also to determine the prevalence and incidence of NTM in our cohort. Methods: We analyzed NMT data in our CF Centre from 1st January to 31st December 2016: according to the last consensus recommendations, we performed annually sputum NTM culture only in spontaneously expectorating pts (108 pts out of 167 pts). Results: Ninety of 108 (85%) had at least 1 mycobacterial culture. Ten of 90 were positive in³ 2 cultures: in 4 cases (2 M. a. abscessus, 1 M. avium, 1 M. intracellulare) the infection was already known. Median age of pts with positive cultures was 20.7 years (range: 11.8–39.7 y). Eight out of 10 showed concomitant S. aureus chronic pulmonary infection, 5 P. aeruginosa, 1 S. maltophilia, 1 A. xylosoxidans, 1 A. Fumigatus and 2 presented previous history of Allergic Bronchopulmonary Aspergillosis. We also evaluated all pts’ lung function. In 2016 we found 6 new cases (3 M. a. abscessus, 1 M. avium, 2 M. intracellulare) and a prevalence of 11%. M. avium complex and M. abscessus complex showed the same infection rate in our study population. Conclusion: Our results confirm the importance of evaluating all expectorating CF patients because of the increasing incidence and prevalence of NTM infection among all ages also in children. 112 Nontuberculous mycobacteria in cystic fibrosis of western Andalusia
annually in spontaneously expectorating individuals with a stable clinical course. In 2014 we introduced a new selective agar medium; RGM, designed for the isolation of rapidly-growing species of NTM. The objective of this study was to retrospectively assess the impact of introducing this new medium compared with standard AFB culture. Methods: Every sputum sample submitted from a patient with CF was digested with sputasol and 10 μl cultured onto RGM without decontamination of samples. Cough swabs were cultured directly onto RGM medium. Plates were incubated at 30°C for 10 days. Isolates were confirmed by rpoB/ sodA/hsp65 sequence cluster analysis and VNTR typing. Standard AFB culture was performed only when specifically requested using the Mycobacterial Growth Indicator Tube (MGIT) and culture on LowensteinJensen medium. We retrospectively analyzed 15 months of data to assess the rates of detection of NTM using these two approaches. Results: Every respiratory sample submitted from 625 patients with CF was cultured using RGM medium without decontamination of samples. This allowed the detection of NTM in 56 patients. Over the same time period, requests for formal AFB culture were submitted for 235 patients with CF and NTM were recovered from 21 patients. Conclusion: NTM were detected from more than twice as many patients (56 vs. 22) by routine use of RGM rather than relying on annual submission of specimens for formal AFB culture. Using RGM medium, NTM was first detected from 15 patients using cough swabs, whereas AFB culture is not recommended for these samples. RGM is a highly selective agar that can be incorporated into routine use for all CF respiratory samples for the isolation of NTM. 109 Mycobacterium abscessus infection in cystic fibrosis, our clinical experience I. González Márquez1, M.E. Quintana-Gallego1, M. Domínguez Begines1, M.J. Moreno Valera1, L. Carrasco Hernández1, M.P. Gaboli1, I. Delgado-Pecellín1. 1Hospital Universitario Virgen del Rocío, CF Unit, Sevilla, Spain
S93
Introduction: Nontuberculous mycobacteria (NTM) are emerging pathogens in CF patients. Aim: To assess NTM prevalence and associated features in a adult CF Centre. Methods: Clinical records from adult CF patients regularly followed between 2013 and 2016 were reviewed. Sputum microbiology, age, concomitant medication, diagnostic criteria, treatment regimens were evaluated. Results: From 51 patients five patients (16–44years) had NTM detected in sputum analysis resulting in a 9.8% prevalence rate. Two patients had Mycobacterium abcessus (M. abcessus) and 3 patients had Mycobacterium avium complex (MAC). All had Aspergillus spp. in sputum microbiology analyses and 3 had chronic PSAE infection. Only the patients with M. abcessus were taking azithromycin previously. 3 patients were using inhaled corticosteroids. A 20%fall of the predicted FEV1 was recorded in one patient, the others maintained their usual values. Four patients meet IDSA/ ATS criteria for NTM pulmonary disease. The two patients with MAC who underwent treatment (ethambutol, rifampicin and clarithromycin), achieved eradication in 12months. One patient relapse two months after ending treatment, maintaining treatment ever since. An intensive regimen (cefotaxime, amikacin and clarithromycin) was applied for 4 weeks to the patients with M. abcessus. The one that underwent maintenance treatment with ciprofloxacin, clarithromycin, doxicycline and inhaled amikacin, achieved eradication in 18 months. The other patient with M. abcessus is currently on maintenance treatment with ciprofloxacin, clarithromycin, doxicycline and inhaled tobramycin for 19 months. Conclusions: Although until 2013 no NMT were detected in our centre, in recent years our prevalence rate (9.8%) is in accordance with the global trend of increasing NTM. No correlation can be made between the presence of NTM and possible risk factors in such a small population. However, our eradication rate (50%) reinforce the difficulty in treating these patients. 111 Non-tuberculous mycobacteria in patients with cystic fibrosis: detection and isolation from respiratory samples. Results of a cross-sectional study
Objectives: Mycobacterium abscessus (M.A.) is a nontuberculous mycobacteria (NTM) frequently isolated in cystic fibrosis (CF). Chronic infection with M.A. is associated with lung function decrease. Our aim is to analyze infection incidence in CF patients and their characteristics, evaluate the treatment used and its repercussion on lung function (FEV1). Methods: Retrospective study of CF patients with M.A infection in a CF reference unit in the last 10 years. Microbiological, genetic, radiological and functional tests were analyzed six months before diagnosis, at diagnosis and after treatment. Results: Ten cases with M.A. infection were identified. Characteristics: 6 (60%) males, 4 (40%) deltaF508 heterozygous mutation, age 26.1 ± 11.97 years. Regarding chronic colonization: 6 patients (60%) colonized by Pseudomonas aeruginosa and 4 (40%) by Staphylococcus aureus. At CT, most common radiological findings were bronchiectasis in all, nodules in 30%. Most common symptoms were: Cough and secretion increase in 5 (50%), hemoptysis in 3 (30%), fever in 2 (20%). Acute episode were treated with carbapenems, amikacin and macrolides for 4–8 weeks, with some cases requiring moxifloxacin and linezolid in addition. 3 patients (30%) received maintenance treatment for up to 18 months. Only 3 patients received macrolide treatment before diagnosis. 70% eradication rate, 3 patients diagnosed in the last months with negative cultures after treatment. No differences were found between FEV1 mean 6 months prior to diagnosis (FEV1 74.2%) and diagnosis (FEV1 73%) or between FEV1 at diagnosis and after treatment (FEV1 77.8%). Conclusion: In our series, M.A. infection was eradicated in most patients, some requiring several cycles or maintenance therapy. Clinical features of CF patients do not allow identification of factors that favor infection. M.A. should be considered in diagnostic and therapeutic algorithm of CF patients and be ruled out in clinical or functional decrease.
B. Fabrizzi1, N. Caporelli1, N. Cirilli1, A.G. Lazarte1, F. Masseria1, M. Cipolli1. 1 Ospedali Riuniti Ancona, Fibrosi Cistica, Ancona, Italy
110 Non-tuberculous mycobacteria in a Portuguese cystic fibrosis centre
M.J. Moreno Valera1, M.E. Quintana-Gallego2, M. Domínguez Begines1, I. González Márquez1, M.P. Gaboli1, L. Carrasco Hernández2, I. Delgado-Pecellín1. 1Hospital Universitario Virgen del Rocío, Unidad de Neumología Pediátrica, Seville, Spain; 2Hospital Universitario Virgen del Rocío, Servicio de Neumología, Seville, Spain
F. Ferro1, C. Lopes1, P. Azevedo1, C. Bárbara1. 1Centro Especializado de Fibrose Quística, Serviço de Pneumologia, Hospital de Santa Maria, CHLN, Lisbon, Portugal
Objectives: Epidemiological studies show a rising prevalence of NTM (Non-tuberculous mycobacteria) positive cultures in respiratory samples from CF patients ( pts) over the last four decades. Active infection can damage lungs causing pulmonary disease in CF individuals. The aim of this study is also to determine the prevalence and incidence of NTM in our cohort. Methods: We analyzed NMT data in our CF Centre from 1st January to 31st December 2016: according to the last consensus recommendations, we performed annually sputum NTM culture only in spontaneously expectorating pts (108 pts out of 167 pts). Results: Ninety of 108 (85%) had at least 1 mycobacterial culture. Ten of 90 were positive in³ 2 cultures: in 4 cases (2 M. a. abscessus, 1 M. avium, 1 M. intracellulare) the infection was already known. Median age of pts with positive cultures was 20.7 years (range: 11.8–39.7 y). Eight out of 10 showed concomitant S. aureus chronic pulmonary infection, 5 P. aeruginosa, 1 S. maltophilia, 1 A. xylosoxidans, 1 A. Fumigatus and 2 presented previous history of Allergic Bronchopulmonary Aspergillosis. We also evaluated all pts’ lung function. In 2016 we found 6 new cases (3 M. a. abscessus, 1 M. avium, 2 M. intracellulare) and a prevalence of 11%. M. avium complex and M. abscessus complex showed the same infection rate in our study population. Conclusion: Our results confirm the importance of evaluating all expectorating CF patients because of the increasing incidence and prevalence of NTM infection among all ages also in children. 112 Nontuberculous mycobacteria in cystic fibrosis of western Andalusia