­­­­­­­­­Surgical Resection Compared to Medical Management in localized Mycobacteria Avium Complex­­­ Pulmonary Infection­­­­s-A Case Control Study

Background Pulmonary infections associated with Mycobacterium avium complex can be challenging to treat medically and the role of surgical lung resection is not well established. We aim to assess safety and microbiologic response in patient with localized Mycobacterium avium complex pulmonary infections managed with surgical lung resection compared to medical management alone. Methods We present a multi-institutional case series of 16 patients with localized Mycobacterium avium complex pulmonary infections managed with surgical lung resection. We highlight the case of a 30 to 40-year-old patient with localized pulmonary disease amenable to surgical resection for illustrative purposes and report on outcomes compared with medically treated patients at the same institution in case-control design. Results Of 745 patients meeting microbiologic diagnostic criteria for Mycobacterium avium complex pulmonary infections, 98 had localized pulmonary disease and of these 16 underwent surgical resection. Univariate and multivariate analysis results indicated no difference in surgical resection group compared with medical treatment: microbiologic response rate (odds ratio 0.49, 0.1–2.41), 2-year all-cause mortality (odds ratio 0.87, 0.18–4.32), and composite outcome of 2-year mortality and lack of microbiological response (multivariate logistic regression OR = 0.45, 0.09–1.57). Conclusions This case series describes patients with localized pulmonary Mycobacterium avium complex for whom surgical resection was pursued and shows examples of patients that may benefit from surgery. Though surgery for pulmonary Mycobacterium avium complex disease is rarely performed, it appears as safe and at least as effective as medical-therapy alone.