FIG 4.

Recurrent pulmonary disease with confirmed M. abscessus complex. The forest plot depicts 10 studies comprising 14 macrolide-containing regimens that were examined after follow-up of 30 patients with M. abscessus subsp. abscessus, 11 patients with M. abscessus subsp. massiliense, and 32 patients with M. abscessus with no subspecies specified. Three hundred sixty-six patients were followed up and were at risk of recurrence; 73 suffered a recurrence. The median follow-up duration for each regimen is shown in the extreme right column in panel A, while the risk of bias is shown in the extreme right column in panel B. Panel A shows that, despite the marked heterogeneity between these regimens (overall I² value of >77%), patients with M. abscessus subsp. abscessus were significantly more likely to have recurrent disease on follow-up, 40% (95% CI, 15 to 67%) compared to 7% (95% CI, 2 to 14%) in patients with M. abscessus subsp. massiliense, as shown by noninterloping confidence intervals between the two subspecies. The findings remain the same when the different follow-up durations are adjusted for, as shown in panel B. Panel C gives the average recurrence rate per month of follow-up, while panel D gives the same estimate per year of follow-up. Panels C and D also show that disease recurrences were significantly higher in studies with low/moderate risk of bias than those with some serious risk across the M. abscessus species.