Epidemiology of nontuberculous mycobacteria among patients with cystic fibrosis in Scandinavia

Abstract

BackgroundNontuberculous mycobacteria (NTM) are an emerging threat to cystic fibrosis (CF) patients but their epidemiology is not well described.MethodsIn this retrospective observational study we identified all Scandinavian CF patients with a positive NTM culture from airway secretions from 2000 to the end of 2012 and used national CF databases to describe microbiological and clinical characteristics.ResultsDuring the 13-year period 157 (11%) CF patients were culture positive for NTM at least once. Mycobacterium abscessus complex (MABSC) (45%) and Mycobacterium avium complex (MAC) (32%) were the predominant species with geographical differences in distribution. Younger patients were more prone to MABSC (p < 0.01). Despite treatment, less than one-third of MABSC patients with repeated positive cultures cleared their infection and a quarter had a lung transplant or died.ConclusionNTM are significant CF pathogens and are becoming more prevalent in Scandinavia. MABSC and MAC appear to target distinct patient groups. Having multiple positive cultures despite treatment conveys a poor outcome.

Chronic pulmonary disease with Mycobacterium abscessus complex is a biofilm infection

“…Among the nontuberculous mycobacteria (NTM), Mycobacterium avium complex (MAC) and the rapidly growing mycobacteria, including MABSC, have been shown to grow as biofilms either in vitro or in environmental reservoirs [4,5], but in vivo conditions have not been studied. MABSC is an emerging threat to patients with cystic fibrosis [6], who become infected at an early age and deteriorate clinically [7] as the persistent infection causes inflammation and tissue damage. We wanted to explore how MABSC grows in the antibiotic-rich, end-stage lungs of patients with cystic fibrosis.…”

“…We simultaneously performed histological and mycobacterial sampling from the same areas, from multiple pulmonary sites. Mycobacterial culture was performed by inoculation on at least one solid (Middlebrooke 7H10 or Löwenstein-Jensen slopes; SSI Diagnostica, Hilleroed, Denmark) and in one liquid culture medium (BACTEC 12B or MGIT; Becton Dickinson Microbiology Systems, Sparks, MD, USA), and a reverse hybridisation DNA assay was performed (InnoLiPA; Fujirebio Europe, Brondby, Denmark), as previously described [7]. Culture morphology was determined by direct visual inspection of colonies and control microscopy used Ziehl-Neelsen staining.…”

“…Bedaquiline (BDQ) is a novel treatment that may be added for 24 weeks to a World Health Organization (WHO) recommended antibiotic background regimen (BR) for the treatment of MDR-TB [7]. WOLFSON et al [8] developed a comprehensive model looking at cost-effectiveness of BDQ plus BR (BDQ+BR) in the UK, over a substantially longer time horizon than a previously published WHO analysis [8,9].…”

“…After adjustment to the perspective of the German Statutory Health Insurance (SHI) system, a cohort-based Markov model was used to estimate the cost-effectiveness of BDQ as an add-on for 24 weeks to a weighted antibiotic BR containing pyrazinamide, one injectable, one fluoroquinolone and one WHO group 4 agent, taking into account different strain resistance patterns as described in the C208 trial and following local guidelines [4,7,11]. This regimen of BDQ+BR was then compared with BR alone for the treatment of MDR-and XDR-TB.…”

Comparison of Mycobacterial Growth Indicator Tube with Culture on RGM Selective Agar for Detection of Mycobacteria in Sputum Samples from Patients with Cystic Fibrosis

“…However, not all NTM will grow on BCSA and overgrowth, particularly by fungi and Gram-negative bacteria, remains a problem (10). Preece et al (11) recently described a new selective agar, RGM medium, to target rapidly growing species of mycobacteria, which represent the dominant species in many geographical areas (3,4,12). The sensitivity of RGM medium proved to be clearly superior to that of BCSA when evaluated with 502 sputum samples from patients with CF.…”