Characteristics of Nontuberculous Mycobacterial Infections at a Midwestern Tertiary Hospital: A Retrospective Study of 365 Patients

Abstract

The prevalence of infections due to nontuberculous mycobacteria (NTM) is increasing worldwide, yet little is known about the epidemiology and pathophysiology of these ubiquitous environmental organisms. Pulmonary disease due to Mycobacterium avium complex (MAC) is most prevalent, but many other NTM species can cause disease in virtually any organ system. As NTM becomes an increasingly common cause of morbidity and mortality, more information is needed about the epidemiology of NTM disease. We conducted a retrospective chart review of all patients with cultures that grew NTM at a Midwestern tertiary hospital from 1996 to 2017. Information on demographics, medical history, clinical findings, treatment, and outcome was obtained from medical records of all NTM isolates. American Thoracic Society/Infectious Diseases Society of America criteria were used to define pulmonary NTM infections. We identified 1064 NTM isolates, 365 of which met criteria for NTM infection. Pulmonary cases predominated (185/365; 50.7%), followed by skin/soft tissue (56/365; 15.3%), disseminated (40/365; 11%), and lymphatic (28/365; 7.7%) disease. MAC was the most common species (184/365; 50.4%). Individuals aged >50 years were most affected (207/365; 56.7%). Common comorbidities included structural lung disease (116/365; 31.8%), use of immunosuppressive medications (78/365; 21.4%), malignancy (59/365; 16.2%), and HIV (42/365; 11.5%). This large cohort provides information on the demographics, risk factors, and disease course of patients with pulmonary and extrapulmonary NTM infections. Most patients had medical comorbidities that resulted in anatomic, genetic, or immunologic risk factors for NTM infection. Further population-based studies and increased disease surveillance are warranted to further characterize NTM infection prevalence and trends.