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Nontuberculous Mycobacteria

I: Multicenter Prevalence Study in Cystic Fibrosis

The Cystic Fibrosis/Pulmonary Research and Treatment Center, the Departments of Epidemiology and Biostatistics, and the Verne S. Caviness General Clinical Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Pulmonary/Critical Care Medicine Flight, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas; the Division of Allergy/Immunology and Respiratory Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina; and the Department of Microbiology, University of Texas Health Center at Tyler, Tyler, Texas

Correspondence and requests for reprints should be addressed to Kenneth N. Olivier, M.D., M.P.H., Wilford Hall USAF Medical Center, 759 MSGS/MCCP (Pulmonary/Critical Care), 2200 Bergquist Drive, Ste 1, Lackland AFB, TX 78236-5300. E-mail: kenneth.olivier{at}lackland.af.mil

Nontuberculous mycobacteria (NTM) are potential respiratory pathogens in cystic fibrosis (CF). To assess the species-specific prevalence and risk factors for acquisition, we conducted a prospective, cross-sectional study of the prevalence of NTM and clinical features of patients at 21 U.S. centers. Almost 10% of patients with CF who were 10 years or older were included (n = 986). The overall prevalence of NTM in sputum was 13.0% (range by center, 7–24%). Mycobacterium avium complex (72%) and Mycobacterium abscessus (16%) were the most common species. When compared with patients with CF without NTM, culture-positive subjects were older (26 vs. 22 years, p < 0.001), had a higher FEV₁ (60 vs. 54%, p < 0.01), higher frequency of Staphylococcus aureus (43 vs. 31%, p < 0.01), and lower frequency of Pseudomonas aeruginosa (71 vs. 82%, p < 0.01). Molecular typing revealed that almost all patients within each center had unique NTM strains. In summary, NTM are common in patients with CF, but neither person-to-person nor nosocomial acquisition explained the high prevalence. Older age was the most significant predictor for isolation of NTM. The clinical significance of NTM in CF is incompletely defined, but patients with these organisms should be monitored with repeat cultures.

Key Words: cystic fibrosis • nontuberculous mycobacteria • mycobacterium infections • Mycobacterium avium-intracellulare • Mycobacterium abscessus

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