Non tuberculous mycobacterial pulmonary disease (NTM-PD) and coinfections: a single center analysis.

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Introduction. NTM-PD presents a significant challenge to treat. Coinfections may complicate treatment worsening respiratory symptoms. Aim. To evaluate patients’ respiratory symptoms after treatment of bacterial or fungal coinfections, and examine potential predisposing factors that may increase the risk of developing simultaneous infections. Methods. We analysed 54 patients (41 females, 13 males) with isolation of NTM, mostly with bronchiectasis, from the IRCCS San Matteo Respiratory Unit. 47 NTM isolations with coinfections were assessed. Additionally, to identify potential predictive factors for coinfection, we divided 41 patients into two groups: those with NTM infection only and those with both NTM and simultaneous fungal infection (25 vs 16 patients respectively). Results. For coinfection, antibiotics were started in 23 out of 29 patients and antifungals in 10 out of 18. Improvement in respiratory symptoms was observed in 19 out of 23 treated with antibiotics (chi-squared = 9.6678, p-value = 0.001875) and in 9 out of 10 cases treated with antifungals (chi-squared = 10.8113, p-value = 0.001009), with a total of 28 cases (chi-squared = 23.0153, p-value < 0.00001). Regarding NTM infection and fungal coinfection, at diagnosis, patients had a higher FACED score and more bronchiectasis-affected lung lobes compared to those with isolated NTM (2.62 vs 1.8 and 3.54 vs 2.7, respectively). Discussion. Our analysis suggests that coinfection treatment may be a feasible option for improvement in symptoms and overall quality of life. A more severe radiological presentation and higher FACED score at diagnosis may increase the likelihood of coinfection.

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