Letter to the Editor
The effect of alcohol consumption in the treatment of nontuberculous mycobacteria
Maria Jacoba,
, Ricardo Silvab, Rita Gaiob,c, Raquel Duarted,e,f
Corresponding author
maria.gsgj@gmail.com
Corresponding author at: Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
Corresponding author at: Pulmonology Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
a Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
b Mathematics Department, Faculty of Sciences of the University of Porto, Porto, Portugal
c Centre of Mathematics of the University of Porto, Porto, Portugal
d ISPUP-EPI Unit, University of Porto, Porto, Portugal
e Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
f Clinical Epidemiology, Predictive Medicine and Public Health Department, Faculty of Medicine of University of Porto, Porto, Portugal
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They are widely distributed in the environment, and several species are associated with a wide range of infections, most commonly affecting the lung.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The increasing number of immunocompromised patients and predisposing diseases – such as chronic obstructive pulmonary disease (COPD), silicosis and bronchiectasis—as well as the increasing life expectancy of patients with cystic fibrosis, are factors contributing to a rising incidence of NTM disease.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> However, patients can develop NTM disease without any apparent underlying cause. This suggests that NTM disease is a multifaceted disease, and the genetic background or environmental exposures could, also, increase susceptibility to infection.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Population-based studies across Europe report a steady increase in NTM isolation and related lung disease over time. In Portugal, epidemiological studies are scarce but are in line with these reports. Two studies, conducted in Lisbon Area, found NTM to account for approximately 12% of all mycobacterial isolates,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> and hospital-based research<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> showed a definite rise in the number of NTM isolates each year of the study, and 89% of those were found to be clinically significant, fulfilling the American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) criteria.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">NTM disease is complex to manage and a significant cause of morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Treatment is long and requires multiple drugs, which can be challenging due to side effects and different resistance profiles.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Therefore, the treatment success rate remains unsatisfactory.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Host factors and comorbidities can influence the outcome, and this is rarely covered by studies reported to date or in the current guidelines.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The present study aimed to identify the effect of alcohol consumption on the treatment outcome of NTM disease.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study collected information from the structured questionnaire filled in by clinicians who initiate treatment for NTM disease and which is stored in the Portuguese National Epidemiological Surveillance Commission for Tuberculosis. We retrospectively reviewed the data from patients with NTM disease from January 2003 to December 2016. All patients met the diagnostic criteria for NTM disease from the ATS/IDSA guidelines. Clinical and socio-demographic data were collected. Alcohol consumption was self-reported in the questionnaire at time of diagnosis and was defined as the presence or absence of consumption. Excluded from the main outcome analysis were patients still in treatment, those who had discontinued the therapy, those lost to follow-up or transferred out.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Treatment outcome of NTM disease was binarily evaluated as a good or bad outcome. Good outcome was defined as culture conversion after initiation of treatment and maintenance of a negative culture for ⩾12 months on treatment. Bad outcome was defined as no culture conversion or as death while being treated for NTM disease. Simple logistic regression models evaluated univariate effects, and multiple logistic regression models identified the simultaneous effects of potential risk factors for a bad outcome. Selection of the final model was based on the backwards algorithm combined with the results from the univariate analysis. The statistical analysis was performed with the R language and software environment for statistical computation [The R Project for Statistical Computing, <a href="https://www.r-project.org/">https://www.r-project.org/</a>, version 3.4.3]. The significance level was set to ≤0.05.</p><p id="par0030" class="elsevierStylePara elsevierViewall">During the study period, 610 patients were eligible. The median age was 58 years (min-max, 19–97 years), and 369 (60%) of the patients were male. The vast majority of patients had NTM lung disease (n = 540, 89%). Alcohol consumption was reported at diagnosis in 65 (11.5%) patients. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the population demographic and clinical characteristics.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A favourable outcome was achieved in 517 (84.8%) patients, and 93 (15.2%) had an unfavourable outcome. The median total antibiotic treatment duration was longer in patients with a good outcome than in those with a bad outcome (376 vs. 167 days; p < 0.001). The (crude) odds ratio (OR) for a bad outcome among the individuals who declared alcohol consumption was almost 3.5 times the same odds for those that declared they did not drink (95% CI:1.91–6.21, p < 0.001).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The final multiple logistic regression model revealed that alcohol consumption was associated with bad outcome (OR 2.01, 95% CI:1.05–3.87, p < 0.001). This effect was adjusted for history of COPD (OR 2.38, 95%CI: 1.22–4.63 p = 0.011) and other co-morbidities (OR 3.29, 95%CI: 1.26–8.61 p = 0.015), cancer (OR 4.47, 95%CI: 1.86–10.72, p = 0.001), having at least one previous treatment (OR 1.86, 95%CI: 1.01–3.43 p = 0.023) and HIV-infection (OR 2.09, 95%CI: 1.2–3.97 p = 0.001). Female gender was identified as a statistically significant protective factor (OR 0.45, 95%CI: 0.24–0.84 p = 0.001). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> represents the Crude OR and Adjusted OR for a bad outcome of NTM disease.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Our results showed that alcohol consumption doubled the odds for a bad outcome, after adjustment for COPD and other comorbidities, cancer, at least one previous treatment, HIV-infection and gender. Among all these confounders, only the female gender was significantly identified as a protective factor.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The ATS/IDSA provides guidelines for the prevention, diagnosis and treatment of NTM infections.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the case of NTM disease—in which immediate symptomatic benefits are not always obvious, and treatments can be long and toxic—compliance with therapy is often low. In every patient, the decision to treat NTM disease involves balancing the benefits and the risks of drug toxicity,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and it is essential to manage the patient’s underlying diseases, such as alcohol dependence, COPD or cancer.</p><p id="par0055" class="elsevierStylePara elsevierViewall">For this study, we relied on self-reported alcohol consumption at diagnosis, which might be the main limitation, as it may not reflect the drinking pattern over the time of the treatment. Other limitations include its retrospective nature, possible incomplete data from the nationwide forms and overestimation of unfavourable outcomes (older patients, more likely to be male, to have alcohol consumption or several comorbidities).</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, this study supports the hypothesis that alcoholism influences the prognosis of NTM disease. After adjustment for potential risk factors, alcohol consumption was estimated to double the odds of an unsuccessful outcome, underlining the need for close monitoring among patients with alcohol dependencies to improve treatment outcomes.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack479924" "titulo" => "Acknowledgment" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-29" "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1593 "Ancho" => 2917 "Tamanyo" => 211658 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Forest Plot representation of the crude odds ratios (above) and adjusted odds ratios (below) for a bad outcome of NTM disease.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">369 (60.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 (19-97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol consumption \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Underlying diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HIV infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drug abuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Imprisonment/Homelessness/Community shelter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTM lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">540 (89) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sputum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">355 (64.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronchoalveolar lavage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">157 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pleural fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Missing data \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTM extra-pulmonary disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Blood culture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lymph node aspirate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Missing data \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Species of nontuberculous mycobacteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Mycobacterium avium/intracellulare</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">340 (55.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. kansasii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 (12.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. gordonae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (6.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. xenopi</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (5.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. chelonae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. fortuitum</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">M. abscessus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (10.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2371331.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the study population - data are presented as n (%) or median (min-max); HIV: human immunodeficiency virus; COPD: chronic obstructive pulmonary disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "CS Haworth" 1 => "J Banks" 2 => "T Capstick" 3 => "AJ Fisher" 4 => "T Gorsuch" 5 => "IF Laurenson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thoraxjnl-2017-210927" "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2017" "volumen" => "72" "numero" => "Suppl 2" "paginaInicial" => "ii1" "paginaFinal" => "ii64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29054853" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "DE Griffith" 1 => "T Aksamit" 2 => "BA Brown-Elliott" 3 => "A Catanzaro" 4 => "C Daley" 5 => "F Gordin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200604-571ST" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2007" "volumen" => "175" "numero" => "4" "paginaInicial" => "367" "paginaFinal" => "416" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17277290" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-tuberculous mycobacteria: epidemiological pattern in a reference laboratory and risk factors associated with pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J Mencarini" 1 => "C Cresci" 2 => "MT Simonetti" 3 => "C Truppa" 4 => "G Camiciottoli" 5 => "ML Frilli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0950268816002521" "Revista" => array:7 [ "tituloSerie" => "Epidemiol Infect" "fecha" => "2017" "volumen" => "145" "numero" => "3" "paginaInicial" => "515" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27804902" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-tuberculous mycobacterial pulmonary infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "JD Chalmers" 1 => "T Aksamit" 2 => "ACC Carvalho" 3 => "A Rendon" 4 => "I. Franco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pneumol" "fecha" => "2018" "volumen" => "24" "numero" => "2" "paginaInicial" => "120" "paginaFinal" => "131" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-tuberculous mycobacteria in HIV-negative patients with pulmonary disease in Lisbon, Portugal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A Amorim" 1 => "R Macedo" 2 => "A Lopes" 3 => "I Rodrigues" 4 => "E. Pereira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/00365541003754485" "Revista" => array:7 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "2010" "volumen" => "42" "numero" => "8" "paginaInicial" => "626" "paginaFinal" => "628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20632900" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of nontuberculous mycobacteria in clinical samples using molecular methods: a 3-year study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I Couto" 1 => "D Machado" 2 => "M Viveiros" 3 => "L Rodrigues" 4 => "L. Amaral" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2009.03076.x" "Revista" => array:7 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2010" "volumen" => "16" "numero" => "8" "paginaInicial" => "1161" "paginaFinal" => "1164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19832711" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nontuberculous mycobacteria in respiratory specimens: clinical significance at a tertiary care hospital in the north of Portugal.J Bras Pneumol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H Dabo" 1 => "V Santos" 2 => "A Marinho" 3 => "A Ramos" 4 => "T Carvalho" 5 => "M Ribeiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/S1806-37132015000000005" "Revista" => array:7 [ "tituloSerie" => "J. Bras Pneumol" "fecha" => "2015" "volumen" => "41" "numero" => "3" "paginaInicial" => "292" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26176531" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack479924" "titulo" => "Acknowledgment" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">Rita Gaio was partially supported by <span class="elsevierStyleGrantSponsor" id="gs0005">CMUP</span> (<span class="elsevierStyleGrantNumber" refid="gs0005">UID/MAT/00144/2013</span>), which is funded by <span class="elsevierStyleGrantSponsor" id="gs0010">FCT</span> (Portugal) with national (MEC) and European structural funds (<span class="elsevierStyleGrantSponsor" id="gs0015">FEDER</span>), under the partnership agreement PT2020.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002600000004/v2_202009030742/S2531043719301734/v2_202009030742/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002600000004/v2_202009030742/S2531043719301734/v2_202009030742/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043719301734?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 2 | 16 |
| 2024 October | 92 | 34 | 126 |
| 2024 September | 102 | 32 | 134 |
| 2024 August | 103 | 33 | 136 |
| 2024 July | 98 | 35 | 133 |
| 2024 June | 128 | 19 | 147 |
| 2024 May | 109 | 38 | 147 |
| 2024 April | 108 | 31 | 139 |
| 2024 March | 110 | 24 | 134 |
| 2024 February | 91 | 21 | 112 |
| 2024 January | 63 | 23 | 86 |
| 2023 December | 65 | 33 | 98 |
| 2023 November | 117 | 52 | 169 |
| 2023 October | 71 | 36 | 107 |
| 2023 September | 69 | 36 | 105 |
| 2023 August | 68 | 22 | 90 |
| 2023 July | 86 | 32 | 118 |
| 2023 June | 75 | 18 | 93 |
| 2023 May | 86 | 32 | 118 |
| 2023 April | 75 | 21 | 96 |
| 2023 March | 100 | 23 | 123 |
| 2023 February | 84 | 32 | 116 |
| 2023 January | 59 | 59 | 118 |
| 2022 December | 97 | 30 | 127 |
| 2022 November | 73 | 43 | 116 |
| 2022 October | 124 | 49 | 173 |
| 2022 September | 80 | 40 | 120 |
| 2022 August | 82 | 37 | 119 |
| 2022 July | 87 | 55 | 142 |
| 2022 June | 65 | 28 | 93 |
| 2022 May | 86 | 41 | 127 |
| 2022 April | 74 | 45 | 119 |
| 2022 March | 89 | 46 | 135 |
| 2022 February | 82 | 40 | 122 |
| 2022 January | 71 | 56 | 127 |
| 2021 December | 68 | 35 | 103 |
| 2021 November | 65 | 39 | 104 |
| 2021 October | 74 | 48 | 122 |
| 2021 September | 70 | 35 | 105 |
| 2021 August | 73 | 43 | 116 |
| 2021 July | 63 | 23 | 86 |
| 2021 June | 73 | 46 | 119 |
| 2021 May | 70 | 45 | 115 |
| 2021 April | 161 | 85 | 246 |
| 2021 March | 76 | 61 | 137 |
| 2021 February | 47 | 38 | 85 |
| 2021 January | 48 | 33 | 81 |
| 2020 December | 53 | 24 | 77 |
| 2020 November | 55 | 18 | 73 |
| 2020 October | 51 | 28 | 79 |
| 2020 September | 76 | 56 | 132 |
| 2020 August | 133 | 58 | 191 |
| 2020 July | 176 | 101 | 277 |
| 2020 June | 38 | 28 | 66 |
| 2020 May | 57 | 32 | 89 |
| 2020 April | 63 | 12 | 75 |
| 2020 March | 39 | 17 | 56 |
| 2020 February | 42 | 19 | 61 |
| 2020 January | 33 | 24 | 57 |
| 2019 December | 43 | 20 | 63 |
| 2019 November | 37 | 14 | 51 |
| 2019 October | 4 | 4 | 8 |
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