Mycobacterium avium complex pulmonary disease: new epidemiology and management concepts

医学 氯法齐明 脓肿分枝杆菌 重症监护医学 疾病 抗药性 呋喃西林 阿米卡星 肺炎 非结核分枝杆菌 分枝杆菌复合群 抗生素耐药性 支气管扩张 抗生素 内科学 免疫学 分枝杆菌 肺结核 病理 麻风病 微生物学 传统医学 生物
作者
Leah Lande,J. George,Theodore Plush
出处
期刊:Current Opinion in Infectious Diseases [Ovid Technologies (Wolters Kluwer)]
卷期号:31 (2): 199-207 被引量:18
标识
DOI:10.1097/qco.0000000000000437
摘要

The prevalence of Mycobacterium avium complex (MAC)-related pulmonary disease has been increasing because of environmental factors, changes in organism virulence, and evolving host susceptibility. Treatment is often complicated by adverse effects, development of drug resistance, and refractory disease, with recurrence rates as high as 25-45%.Aerosolization of water, soil, or dusts are the likely sources of MAC-related pulmonary disease in susceptible individuals. The management of MAC-related pulmonary disease requires a multimodality approach, including antimicrobial therapy in appropriate patients, employment of mucus clearance techniques, instituting changes in the individual's home environment and personal habits to reduce environmental exposure to MAC, prevention of reflux, and maintenance of a healthy body weight. When the standard treatment for MAC-related pulmonary disease is not possible because of drug intolerance, antibiotic resistance, or progression of disease, second-line agents such as inhaled amikacin, clofazimine, bedaquiline, and delamanid must be considered, despite limited experience and few studies to guide their use.Individuals who have proven to be susceptible to MAC-related pulmonary disease should institute measures to reduce exposure to environmental sources of infection. Further research is needed to assess the impact of such preventive strategies on the incidence of new infection and disease recurrence. The efficacy of new medications for MAC-related pulmonary disease and their use in different combinations also requires further study.
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