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Risk factors for nontuberculous mycobacterial pulmonary disease (NTM-PD) in Croatia

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Summary

Background

The incidence, geographical distribution and clinical relevance of different nontuberculous mycobacteria (NTM) in Croatia are well described. There are few data on the risk factors for developing NTM pulmonary disease (NTM-PD) in this setting.

Methods

We conducted a retrospective cohort study on all Croatian residents with NTM isolated from respiratory samples in the period from 2006 to 2015 with follow-up to 2018. The American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines were used to establish NTM-PD diagnosis. Clinical, radiological and treatment data were collected from hospital records.

Results

Risk analysis calculations were made on the 439 isolation episodes that were classified as definitive NTM-PD (n = 137) or no disease (n = 302). Female gender, presence of bronchiectasis, low BMI and long-term systemic corticosteroid treatment were independent risk factors associated with NTM-PD. Hemoptysis and malaise were presenting symptoms independently associated with NTM-PD. Chronic obstructive pulmonary disease (COPD) and low/moderate dose inhaled corticosteroid (ICS) treatment were not associated with NTM-PD. High dose ICS treatment was a significant risk factor for developing NTM-PD (aOR = 4.73, CI 1.69-13.23 p = 0.003).

Conclusion

The NTM-PD patients in Croatia are similar to those in other published cohorts in terms of their characteristics and risk factors. The significant dose-dependent association between ICS use and NTM-PD adds to the body of evidence suggesting that high dose ICS use is associated with NTM-PD.

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Acknowledgements

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Goran Glodić, Miroslav Samaržija, Ivan Sabol, Ljiljana Bulat Kardum, Vesna Carević Vladić, Dražen Strelec, Ljiljana Žmak, Ivana Kuhtić, Ante Marušić and Mateja Janković Makek. The first draft of the manuscript was written by Goran Glodić and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Clinic for Respiratory diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia

    Goran Glodić, Miroslav Samaržija, Feđa Džubur, Marko Jakopović, Dina Mihelčić, Sanja Popović Grle & Mateja Janković Makek

  2. School of Medicine, University of Zagreb, Zagreb, Croatia

    Miroslav Samaržija, Feđa Džubur, Marko Jakopović, Sanja Popović Grle, Tomislav Šklebar, Ljiljana Žmak & Mateja Janković Makek

  3. Division of Molecular Medicine, Laboratory od Molecular Virology and Bacteriology, Ruder Boskovic Institute, Zagreb, Croatia

    Ivan Sabol

  4. Department for Respiratory Diseases, Clinical Hospital Center Rijeka, Rijeka, Croatia

    Ljiljana Bulat Kardum

  5. General hospital Dubrovnik, Dubrovnik, Croatia

    Vesna Carević Vladić

  6. Clinic for Radiology, University Hospital Centre Zagreb, Zagreb, Croatia

    Ivana Kuhtić & Ante Marušić

  7. Hospital for pulmonary disease and TBC Klenovnik, Klenovnik, Croatia

    Dražen Strelec

  8. Special Hospital for Respiratory Diseases Rockefellerova, Zagreb, Croatia

    Ana Marija Šola

  9. National Mycobacteria Reference Laboratory, Croatian Institute of Public Health, Zagreb, Croatia

    Ljiljana Žmak

  10. Department of Medical Microbiology, Radboud University Medical Centre, Nijmengen, The Netherlands

    Jakko van Ingen

Authors
  1. Goran Glodić
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  2. Miroslav Samaržija
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  3. Ivan Sabol
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  4. Ljiljana Bulat Kardum
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  5. Vesna Carević Vladić
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  6. Feđa Džubur
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  7. Marko Jakopović
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  8. Ivana Kuhtić
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  9. Ante Marušić
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  10. Dina Mihelčić
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  11. Sanja Popović Grle
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  12. Dražen Strelec
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  13. Tomislav Šklebar
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  14. Ana Marija Šola
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  15. Ljiljana Žmak
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  16. Jakko van Ingen
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  17. Mateja Janković Makek
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Corresponding author

Correspondence to Goran Glodić.

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Conflict of interest

G. Glodić, M. Samaržija, I. Sabol, Lj. Bulat Kardum, V. Carević Vladić, F. Džubur, M. Jakopović, I. Kuhtić, A. Marušić, D. Mihelčić, S. Popović Grle, D. Strelec, T. Šklebar, A.M. Šola, L. Žmak, J. van Ingen and M. Janković Makek declare that they have no competing interests.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008The study was approved by the ethics committee of the Croatian Institute of Public Health (file number 001-487/1-10). Informed consent was obtained from all patients for being included in the study.

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Glodić, G., Samaržija, M., Sabol, I. et al. Risk factors for nontuberculous mycobacterial pulmonary disease (NTM-PD) in Croatia. Wien Klin Wochenschr 133, 1195–1200 (2021). https://doi.org/10.1007/s00508-021-01923-x

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  • DOI: https://doi.org/10.1007/s00508-021-01923-x

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