Impact of surgical intervention in patients with macrolide-resistant mycobacterium avium complex pulmonary disease: A multicenter study

Abstract OBJECTIVES 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. METHODS 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. RESULTS 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 = 0.72, 0.47, and 0.78, respectively). Multivariable analysis revealed older age and lack of amikacin use as independent risk factors for infectious relapse, but not macrolide resistance. CONCLUSIONS 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.