Baces score and treatment outcomes in patients with mycobacterium avium complex pulmonary disease

SESSION TITLE: Fungal and Mycobacterial Infection: When Its TB and Not TB SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 10:30 am - 11:30 am PURPOSE: A priori prediction of treatment outcomes in patients with Mycobacterium avium complex pulmonary disease (MAC-PD) can be difficult for clinicians. The BACES score is composed of BMI <18.5 kg/m2, age ≥65 years, presence of cavity, elevated ESR, and male sex and can predict mortality in patients with non-tuberculous mycobacteria (NTM) pulmonary disease. Validation of this score was in Asian patients and included not only infections with MAC but other pathogenic NTM species, such as M. abscessus complex, which is often associated with suboptimal treatment outcomes. It is unknown if the BACES score can be applied to MAC-PD patients in the United States nor if this score can also predict treatment outcomes in patients with non-cavitary MAC-PD. We hypothesize that the BACES score is associated with poor outcomes in MAC-PD patients treated with antibiotics and not treated with antibiotics. METHODS: We designed a retrospective cohort study analyzing clinical, microbiological, and radiological outcomes in patients diagnosed with MAC-PD based on current guidelines criteria. We included patients without significant cavitary disease and categorized them into two groups: those who received guidelines-based antibiotics or not over two years. We compared the demographics, clinical, radiologic, and microbiological findings, and treatment outcomes by BACES scores across these two study groups. Associations were evaluated with comparison statistics for categorical variables and non-parametric statistics for continuous variables as appropriate. RESULTS: 104 MAC-PD patients met inclusion criteria, including 60 antibiotic-treated patients and 44 non-antibiotic treated patients (i.e., airways clearance only). The mean ages were 66.7 and 73.1 in the antibiotic-treated and non-antibiotic groups, respectively (p = 0.01). Clinical improvement (88.3%, 100%, p = 0.02), radiological improvement (83.6%, 92.3%, p= 0.21) and overall response (88.3%, 100%, p= 0.02) were higher in the non-antibiotic treated group compared to the antibiotic-treated group; however, sputum/culture conversion was higher in the antibiotic-treated group (88.7%) compared to non-antibiotic treated group (55.2%) (p = 0.01). In the antibiotic-treated group, we found that clinical improvement was 93.8% with BACES score 0, 93.1% with score 1, 78.6% with score 2, and 0% with score 3 (p = 0.01); radiological improvement was 60%, 39.3, 45.5% and 0%, respectively (p = 0.02); overall improvement was 93.75%, 93.1%, 78.6% and 0%, respectively (p = 0.02); Sputum conversion was not statistically associated with BACES (p=0.56); however, in non-antibiotic-treated group, culture conversion was 100% with BACES score of 0, 43.7% with 1, 33.3% with 2 and 0% with 3 (p = 0.02). The non-antibiotics treated group outcomes on clinical, radiological, and overall improvement did not show any statistical association with the BACES score. CONCLUSIONS: BACES score showed a significant association with clinical and radiologic treatment outcomes but not with sputum microbiological outcomes in MAC-PD patients receiving antibiotics. However, BACES score was not associated with these treatment outcomes in patients managed without antibiotics. CLINICAL IMPLICATIONS: BACES score may be clinically useful to predict outcomes in MAC-PD patients treated with antibiotics in the United States, but additional studies are needed to validate BACES and other risk scores in patients with MAC-PD in various settings. DISCLOSURES: No relevant relationships by Pedro Arias-Sanchez No relevant relationships by Elyse Conley No relevant relationships by Patricio Escalante, value=Honoraria given to institution Removed 12/05/2022 by Patricio Escalante, source=Web Response No relevant relationships by Nianqiao Phyllis Ju No relevant relationships by Snigdha Karnakoti No relevant relationships by Paige Marty No relevant relationships by Balaji Pathakumari No relevant relationships by Tobias Peikert No relevant relationships by Kelly Pennington No relevant relationships by Elsje Pienaar No relevant relationships by Mounika Reddy Vadiyala No relevant relationships by Virginia VanKeulen