Mycobacterium Infections, Nontuberculous Clinical Trial
Official title:
A Prospective Registry For Non Tuberculous Mycobacterial (NTM) Infections
The study aims to address the following aims
1. To provide an overview of the epidemiology of the patients who are managed in the
Singapore General Hospital for NTM infections.
2. To evaluate the medical care of patients in the institution with regards to the type of
medical and/or surgical treatment received and specifically, the antibiotic regime and
duration administered.
3. A longitudinal follow up which will allow an assessment of our care and patient outcome
in this population cohort
Nontuberculous Mycobacteria (NTM) is difficult to treat and has no standardised antibiotic
therapy. There have been increasing recognition of the need for measurements of NTM care
around the world, as rates of NTM infections have begun to supercede Tuberculosis infections
for the first time. As health care-associated NTM outbreaks also pose an infection control
risk for patients undergoing surgery, this study provides a platform for further greater
uniformity and opportunities for improvement in care. (1,2)
Singapore General Hospital (SGH) is a tertiary hospital and sees patients of various complex
medical illnesses. Patients with Nontuberculous Mycobacteria (NTM) infections are also on
follow up with the infectious diseases specialists SGH. The care of NTM patients can last
many years, with patients requiring multiple admissions for reinfections/relapses and are
often on long term suppressive therapy and follow up at the Specialist Outpatient Clinic.
(3,4)The lack of standardised care for NTM patients, lengthy treatment time for NTM
infections, as well as increases in macrolide-resistant NTM infections, warrants a need for
research into the epidemiology and best practice to treat this group of patients. (5,6) We
seek to better define the epidemiology of this group of patients and hope to objectively
measure the effectiveness and quality of our NTM care delivery in SGH.
Currently there is a lack of a systematic database to track our quality of care and support
services. As there are many Infectious Diseases Specialists in the department, each may have
slight variation in clinical practice and preference in the face of a lack of proper
treatment guideline. We believe NTM management can be improved with a consistent care
delivery pathway and more standardization of therapy and follow up plan. This will lead to
better desired patient outcome. This prospective observational data collection will allow us
to evaluate our current standard of care for these patients, which can lead to
identification for areas of improvement so that we can refine our strategies and implement
more effective and standardized guidelines in the future.
1. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM,
Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace
RJ Jr, Winthrop K. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention
of Nontuberculous Mycobacterial Diseases. Am J Respir Crit Care Med 2007; Feb
15;175(4):367-416
2. Cook JL. Nontuberculous mycobacteria: opportunistic environmental pathogens for
predisposed hosts. Br Med Bull 2010;96:45-59
3. Piersimoni C. Nontuberculous mycobacteria infection in solid organ transplant
recipients. European Journal of Clinical Microbiology & Infectious Diseases 2012
Apr;31(4):397-403
4. Payen MC, De Wit S, Clumeck N. Manifestations, diagnosis and treatment of
non-tuberculous mycobacterial infections in patients with HIV infection. Revue des
Maladies Respiratoires 1997 Dec;14 Suppl 5:S142-51
5. Russell CD, Claxton P, Doig C, Seagar AL, Rayner A, Laurenson IF. Non-tuberculous
mycobacteria: a retrospective review of Scottish isolates from 2000 to 2010. Thorax
2013 [Epub ahead of print]
6. Binder AM, Adjemian J, Olivier KN, Prevots DR. Epidemiology of Nontuberculous
Mycobacterial Infections and Associated Chronic Macrolide Use among Persons with Cystic
Fibrosis. American Journal of Respiratory and Critical Care Medicine 2013; [Epub ahead
of print]
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