Systematic Review and Meta-analyses of the Effect of Chemotherapy on Pulmonary Mycobacterium Abscessus Outcomes and Disease Recurrence

In pharmacokinetic/pharmacodynamic models of pulmonary complex, the recommended macrolide-containing combination therapy has poor kill rates. However, clinical outcomes are unknown. We searched the literature for studies published between 1990 and 2017 that reported microbial outcomes in patients treated for pulmonary disease. A good outcome was defined as sustained sputum culture conversion (SSCC) without relapse. Random effects models were used to pool studies and estimate proportions of patients with good outcomes. Odds ratios (OR) and 95% confidence intervals (CI) were computed. Sensitivity analyses and metaregression were used to assess the robustness of findings. In 19 studies of 1,533 patients, combination therapy was administered to 508 patients with subsp. , 204 with subsp. , and 301 with with no subspecies specified. Macrolide-containing regimens achieved SSCC in only 77/233 (34%) new subsp. patients versus 117/141 (54%) subsp. patients (OR, 0.108 [95% CI, 0.066 to 0.181]). In refractory disease, SSCC was achieved in 20% (95% CI, 7 to 36%) of patients, which was not significantly different across subspecies. The estimated recurrent rates per month were 1.835% (range, 1.667 to 3.196%) for subsp. versus 0.683% (range, 0.229 to 1.136%) for subsp. (OR, 6.189 [95% CI, 2.896 to 13.650]). The proportion of patients with good outcomes was 52/223 (23%) with subsp. versus 118/141 (84%) with subsp. disease (OR, 0.059 [95% CI, 0.034 to 0.101]). subsp. pulmonary disease outcomes with the currently recommended regimens are atrocious, with outcomes similar to those for extensively drug-resistant tuberculosis. Therapeutically, the concept of nontuberculous mycobacteria is misguided. There is an urgent need to craft entirely new treatment regimens.