Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors

Claire Andréjak; Vibeke O Thomsen; Isik S Johansen; Anders Riis; Thomas L Benfield; Pierre Duhaut; Henrik T Sørensen; François-Xavier Lescure; Reimar W Thomsen

doi:10.1164/rccm.200905-0778OC

Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors

Claire Andréjak, Vibeke O Thomsen, Isik S Johansen, Anders Riis, Thomas L Benfield, Pierre Duhaut, Henrik T Sørensen, François-Xavier Lescure, Reimar W Thomsen

163 Citations (Scopus)

Abstract

Rationale: Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. Objectives: To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. Methods: All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. Measurements and Main Results:We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. Conclusions: NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.

Original language	English
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	181
Issue number	5
Pages (from-to)	514-21
Number of pages	7
ISSN	1073-449X
DOIs	https://doi.org/10.1164/rccm.200905-0778OC
Publication status	Published - 1 Mar 2010

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10.1164/rccm.200905-0778OC

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@article{e11577c0fdfc11de825d000ea68e967b,

title = "Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors",

abstract = "Rationale: Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. Objectives: To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. Methods: All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. Measurements and Main Results:We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. Conclusions: NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.",

author = "Claire Andr{\'e}jak and Thomsen, {Vibeke O} and Johansen, {Isik S} and Anders Riis and Benfield, {Thomas L} and Pierre Duhaut and S{\o}rensen, {Henrik T} and Fran{\c c}ois-Xavier Lescure and Thomsen, {Reimar W}",

year = "2010",

month = mar,

day = "1",

doi = "10.1164/rccm.200905-0778OC",

language = "English",

volume = "181",

pages = "514--21",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "5",

}

TY - JOUR

T1 - Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors

AU - Andréjak, Claire

AU - Thomsen, Vibeke O

AU - Johansen, Isik S

AU - Riis, Anders

AU - Benfield, Thomas L

AU - Duhaut, Pierre

AU - Sørensen, Henrik T

AU - Lescure, François-Xavier

AU - Thomsen, Reimar W

PY - 2010/3/1

Y1 - 2010/3/1

N2 - Rationale: Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. Objectives: To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. Methods: All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. Measurements and Main Results:We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. Conclusions: NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.

AB - Rationale: Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis. Objectives: To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors. Methods: All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization. Measurements and Main Results:We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death. Conclusions: NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.

U2 - 10.1164/rccm.200905-0778OC

DO - 10.1164/rccm.200905-0778OC

M3 - Journal article

C2 - 20007929

SN - 1073-449X

VL - 181

SP - 514

EP - 521

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 5

ER -

Nontuberculous Pulmonary Mycobacteriosis in Denmark: Incidence and Prognostic Factors

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