Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline

doi:10.1183/13993003.00535-2020

Practice Guideline

. 2020 Jul 7;56(1):2000535.

doi: 10.1183/13993003.00535-2020. Print 2020 Jul.

Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline

Charles L Daley^{1

2

3}, Jonathan M Iaccarino⁴, Christoph Lange^{5

6

7

8

3}, Emmanuelle Cambau^{9

3}, Richard J Wallace Jr^{10

3}, Claire Andrejak^{11

12}, Erik C Böttger¹³, Jan Brozek¹⁴, David E Griffith¹⁵, Lorenzo Guglielmetti^{9

16}, Gwen A Huitt^{1

2}, Shandra L Knight¹⁷, Philip Leitman¹⁸, Theodore K Marras¹⁹, Kenneth N Olivier²⁰, Miguel Santin²¹, Jason E Stout²², Enrico Tortoli²³, Jakko van Ingen²⁴, Dirk Wagner²⁵, Kevin L Winthrop²⁶

Affiliations

¹ Dept of Medicine, National Jewish Health, Denver, CO, USA.
² Dept of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
³ C.L. Daley, C. Lange, E. Cambau and R.J. Wallace Jr are cochairs of this guideline committee.
⁴ Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
⁵ Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
⁶ German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany.
⁷ Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.
⁸ Dept of Medicine, Karolinska Institute, Stockholm, Sweden.
⁹ National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France.
¹⁰ Mycobacteria/Nocardia Laboratory, Dept of Microbiology, The University of Texas Health Science Center, Tyler, TX, USA.
¹¹ Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France.
¹² EA 4294, AGIR, Jules Verne Picardy University, Amiens, France.
¹³ Institute of Medical Microbiology, National Reference Center for Mycobacteria, University of Zurich, Zurich, Switzerland.
¹⁴ Dept of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Hamilton, ON, Canada.
¹⁵ Pulmonary Infectious Disease Section, University of Texas Health Science Center, Tyler, TX, USA.
¹⁶ Team E13 (Bactériologie), Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Université Pierre et Marie Curie, Université Paris 06, Centre de Recherche 7, INSERM, IAME UMR1137, Paris, France.
¹⁷ Library and Knowledge Services, National Jewish Health, Denver, CO, USA.
¹⁸ NTM Info and Research, Miami, FL, USA.
¹⁹ Dept of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada.
²⁰ Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
²¹ Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
²² Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA.
²³ Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
²⁴ Radboud Center for Infectious Diseases, Dept of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁵ Division of Infectious Diseases, Dept of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
²⁶ Divisions of Infectious Diseases, Schools of Public Health and Medicine, Oregon Health and Science University, Portland, OR, USA.

PMID: 32636299
PMCID: PMC8375621
DOI: 10.1183/13993003.00535-2020

Practice Guideline

Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline

Charles L Daley et al. Eur Respir J. 2020.

. 2020 Jul 7;56(1):2000535.

doi: 10.1183/13993003.00535-2020. Print 2020 Jul.

Authors

Affiliations

¹ Dept of Medicine, National Jewish Health, Denver, CO, USA.
² Dept of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
³ C.L. Daley, C. Lange, E. Cambau and R.J. Wallace Jr are cochairs of this guideline committee.
⁴ Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
⁵ Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
⁶ German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany.
⁷ Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.
⁸ Dept of Medicine, Karolinska Institute, Stockholm, Sweden.
⁹ National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France.
¹⁰ Mycobacteria/Nocardia Laboratory, Dept of Microbiology, The University of Texas Health Science Center, Tyler, TX, USA.
¹¹ Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France.
¹² EA 4294, AGIR, Jules Verne Picardy University, Amiens, France.
¹³ Institute of Medical Microbiology, National Reference Center for Mycobacteria, University of Zurich, Zurich, Switzerland.
¹⁴ Dept of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Hamilton, ON, Canada.
¹⁵ Pulmonary Infectious Disease Section, University of Texas Health Science Center, Tyler, TX, USA.
¹⁶ Team E13 (Bactériologie), Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Université Pierre et Marie Curie, Université Paris 06, Centre de Recherche 7, INSERM, IAME UMR1137, Paris, France.
¹⁷ Library and Knowledge Services, National Jewish Health, Denver, CO, USA.
¹⁸ NTM Info and Research, Miami, FL, USA.
¹⁹ Dept of Medicine, University of Toronto and University Health Network, Toronto, ON, Canada.
²⁰ Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
²¹ Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
²² Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA.
²³ Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
²⁴ Radboud Center for Infectious Diseases, Dept of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁵ Division of Infectious Diseases, Dept of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
²⁶ Divisions of Infectious Diseases, Schools of Public Health and Medicine, Oregon Health and Science University, Portland, OR, USA.

PMID: 32636299
PMCID: PMC8375621
DOI: 10.1183/13993003.00535-2020

Abstract

Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.

Copyright © The Author(s) 2020. This version published by the European Respiratory Society in the European Respiratory Journal, and jointly with Clinical Infectious Diseases. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.

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Conflict of interest statement

Conflict of interest: C.L. Daley served on advisory committees for Cipla, Horizon, Insmed, Johnson & Johnson, Matinas Biopharma, Otsuka America Pharmaceutical, Paratek, and Spero; received research support from Beyond Air, Insmed, and Spero; served as a consultant for Meiji. Conflict of interest: J.M. Iaccarino has nothing to disclose. Conflict of interest: C. Lange served as a speaker for Berlin Chemie, Chiesi, Gilead, Janssen, Lucane, and Novartis; served on an advisory committee for Oxford Immunotec. Conflict of interest: E. Cambau has nothing to disclose. Conflict of interest: R.J. Wallace Jr served as the director of a university clinical laboratory that does NTM identification, molecular strain comparison, and susceptibility testing; received research support from Insmed as mycobacterial reference laboratory for a trial of the inhaled liposomal amikacin. Conflict of interest: C. Andrejak received research support from Insmed. Conflict of interest: E.C. Böttger served as a consultant for AID Diagnostika, Becton Dickinson, and COPAN; provided expert testimony for Shuttleworth & Ingersoll law firm. Conflict of interest: J. Brozek has nothing to disclose. Conflict of interest: D.E. Griffith served on an advisory committee, as a consultant, as a speaker and received research support from Insmed; served as a consultant for Johnson & Johnson, Merck, and Spero. Conflict of interest: L. Guglielmetti has nothing to disclose. Conflict of interest: G.A. Huitt served on an advisory committee for Hill-Rom and Insmed. Conflict of interest: S.L. Knight has nothing to disclose. Conflict of interest: P. Leitman served as the president of NTM Info & Research, Inc, during which time the organization received support from Insmed, Grifols, BeyondAir, Aradigm, Spero Therapeutics, Johnson & Johnson, Hill-Rom, International Biophysics, Electromed, RespirTech, Maxor Specialty Pharmacy, PantherX, and Kroger Specialty Pharmacy. Conflict of interest: T.K. Marras served as a consultant and received research support from Insmed; served as a speaker for AstraZeneca and Novartis; served as a consultant for Horizon, Spero, and RedHill Biopharma. Conflict of interest: K.N. Olivier received research support from AIT Therapeutics, Insmed, and Matinas Biopharma. Conflict of interest: M. Santin received personal fees from DiaSorin SPA and Vircell SL. Conflict of interest: J.E. Stout has nothing to disclose. Conflict of interest: E. Tortoli has nothing to disclose. Conflict of interest: J. van Ingen served on an advisory committee and as a consultant for Insmed; served on advisory committees for Janssen Pharmaceuticals and Spero. Conflict of interest: D. Wagner served as a speaker for Cepheid GmbH; received research support and travel expenses from Insmed. Conflict of interest: K.L. Winthrop served on an advisory committee for Insmed, Johnson and Johnson, Paratek, Redhill Biopharma, and Spero; served as a consultant for Bayer Healthcare, Bristol-Myers Squibb, Horizon, Lilly, Pfizer, and RedHill Biopharma; received research support from Bristol-Myers Squibb, Cellestis, and Insmed; served on data safety and monitoring boards for Abbvie, Biomarin, Gilead, Roche, and UCB.

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References

1. Schunemann HJ, Jaeschke R, Cook DJ, et al.An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 2006; 174(5): 605–14. - PubMed
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[1] Schunemann HJ, Jaeschke R, Cook DJ, et al.An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 2006; 174(5): 605–14. - PubMed

[2] Schunemann HJ, Jaeschke R, Cook DJ, et al.An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 2006; 174(5): 605–14. - PubMed

[3] Guyatt G, Oxman AD, Akl EA, et al.GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64(4): 383–94. - PubMed

[4] Guyatt G, Oxman AD, Akl EA, et al.GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64(4): 383–94. - PubMed

[5] Andrews JC, Schunemann HJ, Oxman AD, et al.GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013; 66(7): 726–35. - PubMed

[6] Andrews JC, Schunemann HJ, Oxman AD, et al.GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation’s direction and strength. J Clin Epidemiol 2013; 66(7): 726–35. - PubMed

[7] Griffith DE, Aksamit T, Brown-Elliott BA, et al.An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175(4): 367–416. - PubMed

[8] Griffith DE, Aksamit T, Brown-Elliott BA, et al.An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175(4): 367–416. - PubMed

[9] Tsukamura M Diagnosis of disease caused by Mycobacterium avium complex. Chest 1991; 99(3): 667–9. - PubMed

[10] Tsukamura M Diagnosis of disease caused by Mycobacterium avium complex. Chest 1991; 99(3): 667–9. - PubMed

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Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline

Affiliations

Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline

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