{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:10:23Z","timestamp":1787238623838,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,2]],"date-time":"2020-05-02T00:00:00Z","timestamp":1588377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["18fk0108043j0002"],"award-info":[{"award-number":["18fk0108043j0002"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Multidrug therapy is essential for preventing respiratory failure in patients with highly progressive Mycobacterium avium complex pulmonary disease (MAC-PD). However, the prognosis and long-term outcome following combination therapy is poorly understood. Methods: We retrospectively evaluated the clinical characteristics and long-term outcomes in patients with chemo-na\u00efve progressive MAC-PD, hospitalized for first-line multidrug therapy. Results: Among 125 patients, 86 (68.8%) received standardized treatment (rifampicin, ethambutol, clarithromycin), 25 (20.0%) received a fluoroquinolone (FQ)-containing regimen, and 53 (42.4%) received aminoglycoside injection. The sputum conversion rate was 80.0%, and was independently associated with standardized treatment. The incidence of refractory disease (45.6%) was independently and negatively associated with standardized regimen and aminoglycoside use. Choice of an FQ-containing regimen was not associated with positive outcome. Clarithromycin resistance occurred in 16.8% and was independently associated with refractory disease. MAC-PD-associated death occurred in 3.3% of patients with non-cavitary nodular bronchiectasis (NB) and 21.3% with cavitary MAC-PD over a median follow-up period of 56.4 months. The rates of MAC-PD-associated death were comparable between cavitary-NB and fibrocavitary disease. Concurrent chronic pulmonary aspergillosis (CPA) occurred in 13 (17.3%) patients with cavitary MAC-PD, and age, diabetes mellitus, and CPA were independent risk factors for mortality. Conclusions: Standardized intensive multidrug treatment reduces disease progression and persistence in progressive MAC-PD. Cavitary NB may differ from, rather than being just an advanced stage of, non-cavitary NB. The high incidence and significant mortality of CPA in cavitary MAC-PD highlight the need for early diagnosis and treatment.<\/jats:p>","DOI":"10.3390\/jcm9051315","type":"journal-article","created":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T06:41:20Z","timestamp":1588660880000},"page":"1315","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Long-Term Treatment Outcome of Progressive Mycobacterium avium Complex Pulmonary Disease"],"prefix":"10.3390","volume":"9","author":[{"given":"Kiyoharu","family":"Fukushima","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"},{"name":"Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6368-0686","authenticated-orcid":false,"given":"Seigo","family":"Kitada","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Yao Tokusyuukai General Hospital, 1-17 Wakakusa-cho, Yao, Osaka 581-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Matsuki","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kagawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Oshitani","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyuki","family":"Tsujino","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Miki","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Miki","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kida","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Centre, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan"},{"name":"Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.3201\/eid2206.151086","article-title":"Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan","volume":"22","author":"Namkoong","year":"2016","journal-title":"Emerg. 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