Mycobacterium avium complex infection in non‐cystic fibrosis bronchiectasis

Abstract Background and objective Reliable markers of disease progression or stability to assist in management decisions are lacking in patients with non‐cystic fibrosis bronchiectasis and Mycobacterium avium complex ( MAC ) infection. Methods Data from 52 adults with non‐cystic fibrosis bronchiectasis and coexisting MAC infection managed at our institution over a 5‐year period were retrospectively analysed. High‐resolution computed tomography (HRCT) scans were scored using a scoring system that focused on findings associated with MAC infection. Results Chronic pulmonary aspergillosis was independently associated with mortality (hazard ratio ( HR ) = 8.916, 95% confidence interval ( CI ) = 1.324–60.027), as were nodules with cavitation ( HR = 5.911, 95% CI = 1.095–25.911) and emphysema ( HR = 1.027, 95% CI = 1.002–1.053) on HRCT . Anti‐ MAC chemotherapy was more likely to lead to MAC culture conversion (67% vs 27%, P = 0.005) but did not improve survival as compared with patients managed with observation. Longitudinally, patients who had improvements in HRCT scores were younger (60.2 ± 9.19 years vs 69.83 ± 12.43 years, P = 0.043), while the presence of cavitation within nodules predicted a deterioration in HRCT scores (0.5 (0–3) vs 0 (0–1), P = 0.033). No significant longitudinal differences were found in lung function in the cohort as a whole or within different groups. Conclusions Chronic pulmonary aspergillosis in patients with bronchiectasis and coexisting MAC infection is a strong predictor of mortality. Cavitation within nodules and emphysema on HRCT at presentation were independently associated with mortality.