Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Long-term Outcome of Treatment of Mycobacterium Abscessus Pulmonary Disease

Mycobacterium abscessus 폐질환 치료의 장기 성적

  • Jo, Kyung Uk (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Soo Jung (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Seok Chan (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Oh, Yeon-Mok (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Sang Do (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Woo Sung (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Dong Soon (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Won Dong (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 조경욱 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 박수정 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 홍석찬 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과)
  • Received : 2006.12.11
  • Accepted : 2007.02.14
  • Published : 2007.02.28
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Abstract

Background: Although there is an increasing incidence of Mycobacterium abscessus pulmonary disease in Korea, the optimal therapeutic regimen has not yet been established and there are no reports of the long-term treatment outcomes. This study examined the long-term treatment outcomes of M. abscessus pulmonary disease. Methods: Twenty-nine patients diagnosed with M. abscessus pulmonary according to the American Thoracic Society criteria and treated from January 1996 to December 2003 were enrolled in ghis study. The clinical characteristics, radiological findings, treatment outcome, and follow up data were analyzed retrospectively. Results: The mean age of the 29 patients was 56.1 (${\pm}13.6$) years and there was a female (22/29) dominance. The chest radiography revealed the nodular bronchiectatic type to be dominant (69%, 20/29). Twenty-seven (93.1%) were prescribed clarithromycin-containing regimens, and injectable drugs, mainly aminoglycosides, were included in the regimen of nineteen patients. The most predominant regimen (48.3%) consisted of clarithromycin and amikacin. The treatment success, failure, and default were achieved in 19(65.5%), 9(31.0%), and 1(3.4%), respectively. The median duration to culture conversion was 42 days (range 15-362) and the median duration of treatment in the success group was 543 days (range 176-1,160). An adjunctive surgical resection was performed in five patients, which resulted in treatment success in two patients. After the completion of treatment, nineteen patients were followed up for a median duration of 931 days (range 230-2,294). Only one (5.3%) patient relapsed 45 days after completing treatment. Conclusion: Treatment with clarithromycin-containing regimens resulted in a successful treatment in approximately two thirds of patients with M. abscessus pulmonary disease. The long-term relapse rate was also quite low.

연구배경: M. abscessus 폐질환은 최근 우리나라에서 유병률이 증가하는 질환이다. 국내 M. abscessus 폐감염증에 대한 치료성적 및 치료 후 장기결과에 대해서 알아보고자 의무기록을 후향적으로 분석하였다. 방 법: 1996년부터 2003년까지 서울아산병원에서 미국흉부학회진단기준에 부합하는 35명의 M. abscessus 폐질환 환자 중 치료를 받은 29명의 환자를 대상으로 임상적 특징과 치료, 치료 후 추적결과에 대해 분석하였다. 결 과: 29명의 평균 나이는 56.1세(${\pm}13.6$)였고 여성이 76% 이었으며(22/29), 20명(69%)에서 결절 기관지확장증형이었다. 29명 중 19명(65.5%)에서 치료성공하였고 9명(31%)은 치료실패하였다. 1명은 약물부작용으로 치료를 중단하였다. 치료성공군은 중앙값 543일(범위 176 - 1,160)동안 치료를 받았고, 균배양음전까지의 기간은 중앙값 42일(범위 15-362)이었다. 수술은 5명에서 시행되었으며 한 엽에만 국한된 병변을 가진 두 환자에서 치료성공하였다. 치료 완료 후 중앙값 931일 (범위 230-2294일)동안 추적관찰이 이루어졌고, 19명 중 1명(5.3%)이 재발하였다. 결 론: M. abscessus 폐질환의 세균학적 치료 성적은 외국의 보고에 비하여 우수한 편이며 치료성공 후 재발률은 낮았다.

Keywords

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