{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T01:55:04Z","timestamp":1769565304312,"version":"3.49.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u226532\u2009mg\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009=\u2009.72, .47, and .78, respectively). Multivariable analysis revealed older age and lack of amikacin use as independent risk factors for infectious relapse, but not macrolide resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag004","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T12:24:17Z","timestamp":1767443057000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Surgical Intervention in Patients With Macrolide-Resistant\n                    <i>Mycobacterium avium<\/i>\n                    Complex Pulmonary Disease: A Multicentre Study"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1865-0867","authenticated-orcid":false,"given":"Shota","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Nagoya University Graduate School of Medicine , Nagoya 466-8550,","place":["Japan"]},{"name":"Department of Thoracic Surgery, Daido Hospital , Nagoya, 457-8511,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumie","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital , Nagoya, 466-8560,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukio","family":"Seki","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, NHO Nagoya Medical Center , Nagoya, 460-0001,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohei","family":"Tsunoda","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, NHO Higashinagoya National Hospital , Nagoya, 465-8620,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, NHO Higashinagoya National Hospital , Nagoya, 465-8620,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4157-1112","authenticated-orcid":false,"given":"Taku","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, NHO Higashinagoya National Hospital , Nagoya, 465-8620,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, NHO Higashinagoya National Hospital , Nagoya, 465-8620,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0494-7077","authenticated-orcid":false,"given":"Toyofumi Fengshi","family":"Chen-Yoshikawa","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Nagoya University Graduate School of Medicine , Nagoya 466-8550,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuo","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Daido Hospital , Nagoya, 457-8511,","place":["Japan"]},{"name":"Department of Thoracic Surgery, NHO Higashinagoya National Hospital , Nagoya, 465-8620,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"2026012708121186000_ezag004-B1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1164\/rccm.200604-571ST","article-title":"An official ATS\/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases","volume":"175","author":"Griffith","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012708121186000_ezag004-B2","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1093\/cid\/ciaa1125","article-title":"Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS\/ERS\/ESCMID\/IDSA clinical practice guideline","volume":"71","author":"Daley","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026012708121186000_ezag004-B3","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1164\/ajrccm.153.6.8665032","article-title":"Clarithromycin regimens for pulmonary Mycobacterium avium complex. The first 50 patients","volume":"153","author":"Wallace","year":"1996","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012708121186000_ezag004-B4","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1378\/chest.12-0494","article-title":"Clinical significance of the differentiation between Mycobacterium avium and Mycobacterium intracellulare in M avium complex lung disease","volume":"142","author":"Koh","year":"2012","journal-title":"Chest"},{"key":"2026012708121186000_ezag004-B5","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2017-210927","article-title":"British thoracic society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)","volume":"72","author":"Haworth","year":"2017","journal-title":"Thorax"},{"key":"2026012708121186000_ezag004-B6","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1164\/rccm.200603-450OC","article-title":"Clinical and molecular analysis of macrolide resistance in Mycobacterium avium complex lung disease","volume":"174","author":"Griffith","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012708121186000_ezag004-B7","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1513\/AnnalsATS.201604-246OC","article-title":"Macrolide-resistant Mycobacterium avium complex lung disease: analysis of 102 consecutive cases","volume":"13","author":"Morimoto","year":"2016","journal-title":"Ann Am Thorac Soc"},{"key":"2026012708121186000_ezag004-B8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1513\/AnnalsATS.201304-085OC","article-title":"Lack of adherence to evidence-based treatment guidelines for nontuberculous mycobacterial lung disease","volume":"11","author":"Adjemian","year":"2014","journal-title":"Ann Am Thorac Soc"},{"key":"2026012708121186000_ezag004-B9","doi-asserted-by":"crossref","first-page":"1601855","DOI":"10.1183\/13993003.01855-2016","article-title":"Poor adherence to management guidelines in nontuberculous mycobacterial pulmonary diseases","volume":"49","author":"van Ingen","year":"2017","journal-title":"Eur Respir J"},{"key":"2026012708121186000_ezag004-B10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.rmed.2019.10.002","article-title":"Actual practice of standard treatment for pulmonary nontuberculous mycobacteriosis in Japan","volume":"158","author":"Morimoto","year":"2019","journal-title":"Respir Med"},{"key":"2026012708121186000_ezag004-B11","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.chest.2021.08.004","article-title":"Outcomes of resectional thoracic surgery for the treatment of pulmonary nontuberculous mycobacterial disease in 105 patients in the United States","volume":"161","author":"Ku","year":"2022","journal-title":"Chest"},{"key":"2026012708121186000_ezag004-B12","doi-asserted-by":"crossref","first-page":"6758","DOI":"10.1128\/AAC.01240-16","article-title":"Clinical characteristics, treatment outcomes, and resistance mutations associated with macrolide-resistant Mycobacterium avium complex lung disease","volume":"60","author":"Moon","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"2026012708121186000_ezag004-B13","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1186\/s12931-019-1258-9","article-title":"Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium avium complex pulmonary disease: a systematic review and meta-analysis","volume":"20","author":"Park","year":"2019","journal-title":"Respir Res"},{"key":"2026012708121186000_ezag004-B14","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12879-016-1384-7","article-title":"Analysis of drug treatment outcome in clarithromycin-resistant Mycobacterium avium complex lung disease","volume":"16","author":"Kadota","year":"2016","journal-title":"BMC Infect Dis"},{"key":"2026012708121186000_ezag004-B15","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.jiac.2020.02.008","article-title":"Effective treatment for clarithromycin-resistant Mycobacterium avium complex lung disease","volume":"26","author":"Adachi","year":"2020","journal-title":"J Infect Chemother"},{"key":"2026012708121186000_ezag004-B16","first-page":"323","article-title":"Indications and outcomes of surgical treatment for elderly patients with nontuberculous mycobacterial lung disease","volume":"10","year":"2021","journal-title":"Ann Jpn Respir Soc"},{"key":"2026012708121186000_ezag004-B17","volume-title":"Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes","author":"Woods"},{"key":"2026012708121186000_ezag004-B18","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.athoracsur.2020.05.067","article-title":"Extensive lung resection for nontuberculous mycobacterial lung disease with multilobar lesions","volume":"111","author":"Yamada","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2026012708121186000_ezag004-B19","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/j.athoracsur.2008.02.041","article-title":"Anatomic lung resection for nontuberculous mycobacterial disease","volume":"85","author":"Mitchell","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2026012708121186000_ezag004-B20","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.athoracsur.2013.03.008","article-title":"Adjuvant surgical treatment of nontuberculous mycobacterial lung disease","volume":"96","author":"Shiraishi","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2026012708121186000_ezag004-B21","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s11748-018-1029-4","article-title":"Outcomes and risk factors after adjuvant surgical treatments for Mycobacterium avium complex lung disease","volume":"67","author":"Yamada","year":"2019","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2026012708121186000_ezag004-B22","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.athoracsur.2013.09.013","article-title":"Current surgical therapy for bronchiectasis: surgical results and predictive factors in 86 patients","volume":"97","author":"Balci","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2026012708121186000_ezag004-B23","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/S1010-7940(02)00053-2","article-title":"Surgical treatment in bronchiectasis: analysis of 166 patients","volume":"21","author":"Kutlay","year":"2002","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012708121186000_ezag004-B24","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1093\/cid\/cix274","article-title":"Long-term outcome of pulmonary resection for nontuberculous mycobacterial pulmonary disease","volume":"65","author":"Asakura","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2026012708121186000_ezag004-B25","first-page":"671","article-title":"Lady Windermere revisited: treatment with thoracoscopic lobectomy\/segmentectomy for right middle lobe and lingular bronchiectasis associated with non-tuberculous mycobacterial disease","volume":"40","author":"Yu","year":"2011","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012708121186000_ezag004-B26","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12879-015-0823-1","article-title":"Treatment outcomes of adjuvant resectional surgery for nontuberculous mycobacterial lung disease","volume":"15","author":"Kang","year":"2015","journal-title":"BMC Infect Dis"},{"key":"2026012708121186000_ezag004-B27","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.chest.2022.09.037","article-title":"Outcomes of adjunctive surgery in patients with nontuberculous mycobacterial pulmonary disease: a systematic review and meta-analysis","volume":"163","author":"Kim","year":"2023","journal-title":"Chest"},{"key":"2026012708121186000_ezag004-B28","doi-asserted-by":"crossref","first-page":"e0121324","DOI":"10.1128\/aac.01213-24","article-title":"Variability of macrolide-resistant profile in Mycobacterium avium complex pulmonary disease","volume":"68","author":"Fukushima","year":"2024","journal-title":"Antimicrob Agents Chemother"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezag004\/66285552\/ezag004.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/1\/ezag004\/66285552\/ezag004.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/1\/ezag004\/66285552\/ezag004.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:12:22Z","timestamp":1769519542000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezag004\/8415904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezag004","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2026,1]]},"article-number":"ezag004"}}