The lack of reliable predictors for the treatment response complicates decisions to initiate treatment in patients with Mycobacterium abscessus complex pulmonary disease (MABC-PD). We aimed to investigate whether baseline radiographic disease severity is associated with treatment outcome in MABC-PD.

We retrospectively analyzed 101 patients with MABC-PD (54 with M. abscessus-PD and 47 with M. massiliense-PD) treated in a tertiary referral hospital between January 2006 and December 2019. Using chest computed tomography images, baseline radiographic disease severity was quantitatively scored according to five categories of radiographic lesions (bronchiectasis, bronchiolitis, cavities, nodules, and consolidation).

Treatment success was achieved in 53.7% of patients with M. abscessus-PD and 85.1% of patients with M. massiliense-PD. Higher overall scores for baseline radiographic disease severity were associated with treatment failure in patients with M. massiliense-PD (aOR 1.35, 95% CI 1.02–1.79 for each 1-point increase in severity score), as well as in patients with M. abscessus-PD (aOR 1.15, 95% CI 1.00–1.33). This was particularly prominent in patients with overall severity score of ≥14 (aOR 31.16, 95% CI 1.12–868.95 for M. massiliense-PD and aOR 3.55, 95% CI 1.01–12.45 for M. abscessus-PD). Among variable radiographic abnormalities, the score for cavitary lesion severity was associated with treatment failure in patients with M. abscessus-PD (aOR 1.26, 95% CI 1.01–1.56), but not in patients with M. massiliense-PD.

Given the association between baseline radiographic disease severity and treatment outcome, initiating treatment should be actively considered before significant progression of radiographic lesions in patients with MABC-PD.