Impact of Surgical Intervention in Patients With Macrolide-Resistant Mycobacterium avium Complex Pulmonary Disease: A Multicentre Study

TL;DR

Surgery for macrolide-resistant MAC lung disease is safe and effective, with outcomes similar to non-resistant cases.

Contribution

Demonstrates surgical resection is a viable treatment for macrolide-resistant MAC pulmonary disease.

Findings

5-year survival rates were 100% for MR-MAC and 98.5% for non-MR-MAC patients.

Relapse-free survival was 85.4% for MR-MAC and 67.9% for non-MR-MAC patients.

Older age and lack of amikacin use were risk factors for relapse, not macrolide resistance.

Abstract

Treatment for patients with macrolide-resistant Mycobacterium avium complex (MR-MAC) pulmonary disease is a major clinical challenge, as pharmacologic options are limited and outcomes with antibiotics alone are unsatisfactory. Although surgical intervention has been considered in selected cases, clinical evidence specific to MR-MAC is limited. This study aimed to compare the clinical outcomes of surgical intervention for MR-MAC pulmonary disease to those of non-resistant cases.

This multicentre study included 248 patients who underwent pulmonary resection for MAC pulmonary disease. Among them, 34 patients (13.7%) had MR-MAC, which was defined as isolates with a clarithromycin minimum inhibitory concentration of ≥32 mg/L. Clinical outcomes were compared between the MR-MAC and non-MR-MAC groups. A multivariable analysis was conducted to identify risk factors for infectious relapse.

In the MR-MAC and non-MR-MAC groups, the 5-year overall survival, 5-year relapse-free survival and postoperative complication rates were 100% and 98.5%, 85.4% and 67.9%, and 8.8% and 11.9%, respectively (P = .72, .47, and .78, respectively). Multivariable analysis revealed older age and lack of amikacin use as independent risk factors for infectious relapse, but not macrolide resistance.

Surgical resection is a viable and safe therapeutic option for selected patients with MR-MAC pulmonary disease, with long-term infection control comparable to that of non-MR-MAC cases. These findings support early surgical intervention in carefully selected patients with localized destructive lesions.

Newer macrolides are essential components of multidrug regimens for Mycobacterium avium complex (MAC) pulmonary disease.

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