Tuberc Respir Dis > Accepted Articles
DOI:    [Accepted]
Published online April 30, 2024.
Exploring the association of bacterial co-infections with clinical characteristics of patients with non-tuberculous mycobacterial pulmonary disease
Seong Mi Moon1,2, Hyunkyu Cho1, Beomsu Shin3
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
3Department of Allergy, Pulmonology and Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
Correspondence:  Beomsu Shin,
Received: 7 January 2024   • Revised: 17 March 2024   • Accepted: 24 April 2024
Clinical data for bacterial co-infection of the lower respiratory tract in patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD) are scarce. This study aims to assess the prevalence of bacterial co-infection and clinical features in NTM-PD patients.
This retrospective study screened 248 patients with NTM-PD who underwent bronchoscopy between July 2020 and July 2022, from whom newly diagnosed NTM-PD patients were analyzed. Bacterial culture using bronchial washing fluid was performed at the time of NTM-PD diagnosis.
In the 180 patients (median age 65 years; 68% female), Mycobacterium avium complex (86%) was the most frequent NTM isolated. Bacterial co-infections were detected in 80 (44%) patients. Among them, the most common bacterium was Klebsiella pneumoniae (n = 25/80, 31.3%), followed by Pseudomonas aeruginosa (n = 20/80, 25%) and Staphylococcus aureus (n = 20/80, 25%). Compared with NTM-PD patients without bacterial co-infections, patients with bacterial co-infections showed more frequent extensive lung involvement (33% vs. 1%, p < 0.001). Additionally, compared with NTM-PD patients without P. aeruginosa infection, those with P. aeruginosa infection were older (74 years vs. 64 years, p = 0.001), had more frequent respiratory symptoms (cough/excessive mucus production 70% vs. 38%, p = 0.008; dyspnea 30% vs. 13%, p = 0.047), and had extensive lung involvement (60% vs. 9%, p < 0.001).
Less than half of patients with newly diagnosed NTM-PD had bacterial co-infections, linked to extensive lung involvement. Specifically, P. aeruginosa co-infection was significantly associated with older age, more frequent respiratory symptoms, and extensive lung involvement.
Key Words: Non-tuberculous mycobacteria, bacterial co-infection, bronchiectasis, bronchiectasis severity, Pseudomonas aeruginosa

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