Blog

What are Non-tuberculous Mycobacteria?

October 7, 2021

이 페이지 공유

Non-tuberculous mycobacteria (NTM) are a group of environmental opportunistic pathogens which typically occur in drinking water systems, soils, and dusts. For immunosuppressed, immunocompromised, and other at-risk populations, NTM can cause a variety of infections to those exposed. NTM-caused infections can include those to the lungs, soft tissue, blood, and lymph nodes.

NTM can be transmitted through improperly reprocessed medical devices, direct contact with drinking water, aerosolized water, and even ice machines. NTM has been known to be found in significantly higher quantities in shower heads than the main piping system, making aerosolization risk much higher¹. There has also been data to confirm some person-to-person spread of NTM².

Several species of NTM have become better-known due to increased incidence³. Mycobacterium avium, for example, is responsible for Mycobacterium Avium complex lung and pulmonary disease. Surgical site and lung infections are common sites of M. abscessus infections. M. abscessus is frequently found in cystic fibrosis patients⁴. Mycobacterium chimaera is a species implicated in several outbreaks from heater coolers devices used in open heart surgery.

Concerns: Antimicrobial Resistance, Treatment & Costs

Globally, the prevalence of NTM is growing rapidly³. According to the literature, in the United States cases rose from 2.8 cases per 100,000 population in the 1980’s to 15.2 per 100,000 population in 2013¹. Cases can be hard to diagnose and even harder to treat, as NTM can develop antimicrobial resistance¹ and is difficult to culture. In some cases, these infections can incubate for five or more years before showing symptoms and, when contracted, can require prolonged treatment with high morbidity.

Further, the costs of these infections tend to be very high for hospitals and healthcare facilities. NTM infections can be almost as costly as a Legionella pneumophila infection, somewhere around $25,985 USD per episode⁴. The length of patient stays for NTM infections is typically as long or longer than a patient with Legionella pneumophila and evidence supports higher rates of NTM infections when compared to Legionella pneumophila⁵.

Risk and Prevention

As with many waterborne pathogens, at-risk populations are more likely to acquire a NTM infection. Waterborne NTM in plumbing systems readily form biofilms and have multilayer outer membranes which are thicker than many other bacteria. This membrane helps make NTM especially resistant to chemicals and temperature⁶. Further, NTM require specific conditions to be cultured in a laboratory to confirm their presence.

Understanding NTM’s unique challenges can help us build a more robust water safety and management plan. It may be necessary to incorporate different or additional control measures in your plan to account for this pathogen.

For additional information, please visit: go.pall.com/ntm

References

¹. Ratnatunga, Champa N et al. The Rise of Non-Tuberculosis Mycobacterial Lung Disease. Frontiers in immunology vol. 11 303. 3 Mar. 2020, doi:10.3389/fimmu.2020.00303

². Bryant, Josephine M et al. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium. Science (New York, N.Y.) vol. 354,6313 (2016): 751-757. doi:10.1126/science.aaf8156

³. Falkinham JO 3rd. Common features of opportunistic premise plumbing pathogens. Int J Environ Res Public Health. (2015) 12(5): 4533-45.

⁴ Johnson, Margaret M, and John A Odell. Nontuberculous mycobacterial pulmonary infections. Journal of thoracic disease vol. 6,3 (2014): 210-20. doi:10.3978/j.issn.2072-1439.2013.12.24

⁵. Collier, S A et al. Direct healthcare costs of selected diseases primarily or partially transmitted by water. Epidemiology and infection vol. 140,11 (2012): 2003-13. doi:10.1017/S0950268811002858

⁶. Dowdell, K et al. Nontuberculous mycobacteria in drinking water systems - the challenges of characterization and risk mitigation. Curr Opin Biotechnol. (2019) 57: 127-36

이 페이지 공유

Marissa Khoukaz - Business Development Manager— Hospital Water

Marissa is Pall Medical’s Business Development Manager for Hospital Water and manages the Pall Medical’s prefiltration portfolio globally. She is a healthcare water expert, working with high-risk units to reduce waterborne pathogen risk to patients.

더 읽어보기

적은