Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States

Arthur W Baker^{1

2}, Ricardo M La Hoz³, Judith A Anesi⁴, Jennie H Kwon⁵, Anastasia I Wasylyshyn⁶, Emily S Ford⁷, Susan M Harrington⁸, Melissa B Miller⁹, David J Weber¹⁰, Emily E Sickbert-Bennett¹⁰, Thomas R Talbot¹¹, M Hong Nguyen¹², Kailey Hughes Kramer¹², Katelin B Nickel⁵, Matthew J Ziegler⁴, Doramarie Arocha¹³, Charles Henderson¹³, Yuliya Lokhnygina¹⁴, Ahmed Maged^{15

16}, Salah Haridy^{15

17}, Barbara D Alexander^{1

18}, Jason E Stout¹, Deverick J Anderson^{1

2}

Affiliations

¹ Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
² Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
³ Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
⁶ Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁸ Pathology and Laboratory Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA.
⁹ Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹¹ Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹² Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹³ Department of Health System Infection Prevention and Control, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁴ Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁵ Department of Mechanical Engineering, Benha University, Benha, Egypt.
¹⁶ Department of Mechanical Engineering, University of North Texas, Denton, Texas, USA.
¹⁷ Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, United Arab Emirates.
¹⁸ Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA.

PMID: 40357718
DOI: 10.1093/cid/ciaf169

Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States

Arthur W Baker et al. Clin Infect Dis. 2025.

. 2025 May 13:ciaf169.

doi: 10.1093/cid/ciaf169. Online ahead of print.

Authors

Affiliations

¹ Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
² Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
³ Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
⁶ Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁷ Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.
⁸ Pathology and Laboratory Medicine Department, Cleveland Clinic, Cleveland, Ohio, USA.
⁹ Department of Pathology & Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹¹ Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹² Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹³ Department of Health System Infection Prevention and Control, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁴ Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁵ Department of Mechanical Engineering, Benha University, Benha, Egypt.
¹⁶ Department of Mechanical Engineering, University of North Texas, Denton, Texas, USA.
¹⁷ Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, United Arab Emirates.
¹⁸ Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA.

PMID: 40357718
DOI: 10.1093/cid/ciaf169

Abstract

Background: Data on the epidemiology of healthcare facility-associated (HCFA) nontuberculous mycobacteria (NTM) are sparse. We performed a multicenter longitudinal cohort study of HCFA NTM epidemiology.

Methods: We retrospectively analyzed positive cultures for NTM performed from 2012 through 2020 within a network of 10 US academic hospitals and associated clinics. A unique NTM episode was defined as a patient's first positive culture for a particular NTM species and specimen source category (pulmonary vs extrapulmonary). Episodes linked to specimens obtained on day 3 or later of hospitalization were classified as hospital-onset (HO). Seven hospitals contributed at least 12 months of data prior to January 2014. Within this closed cohort, incidence rate ratios (IRRs) and trends in incidence from 2014 through 2020 were estimated, assuming the number of episodes followed the Poisson distribution.

Results: A total of 12 855 unique NTM episodes occurred from 2012 through 2020 during 19 248 137 patient-days of surveillance. Of these episodes, 3045 (24%) were HO. HO incidence rates were highly variable among hospitals, with a median hospital rate of 1.06 episodes per 10 000 patient-days (range, 0.35-5.48). Within the 7-hospital closed cohort from 2014 through 2020, the incidence rate of HO episodes decreased from 2.29 to 1.42 episodes per 10 000 patient-days (IRR, 0.62; 95% confidence interval, .53-.73; P < .0001).

Conclusions: Incidence rates of HO NTM episodes decreased from 2014 through 2020, but rates varied substantially among hospitals. These results provide comprehensive data on HO NTM isolation, including benchmark rates that can be used to improve hospital-based NTM surveillance.

Keywords: healthcare-associated infections; hospital epidemiology; infection prevention; infection surveillance; nontuberculous mycobacteria.

© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Conflict of interest statement

Potential conflicts of interest. A. W. B. has served as an investigator for 2 clinical trials sponsored by Insmed (payments to institution) and has received grants to their institution from the Centers for Disease Control and Prevention (CDC). A. I. W. has served as an investigator for a clinical trial sponsored by Armada Pharmaceuticals (payments to institution) and has received grants to their institution from the Agency for Healthcare Research and Quality (AHRQ) and the CDC. S. M. H. has received research support from Bruker Daltonics. E. E. S. has received grants to their institution from the CDC, has served on the guidelines committee for the Society for Healthcare Epidemiology of America, and has served as an associate editor for the American Journal of Infection Control. B. D. A. has received grants to their institution from Scynexis, Karius, F2G, and Shire and has received payments from UpToDate, Scynexis, GSK, Astellas, Merck, Basilea, F2G, the Infectious Diseases Board Review Course, and HealthTrackRx. J. E. S. has served as an investigator for a clinical trial sponsored by Medpace/AN2 Therapeutics (payments to institution) and has received payments from UpToDate and the Academy for Continued Healthcare Learning. D. J. A. has received grants to their institution from the AHRQ and the CDC, has received payments from UpToDate, and has been an owner of Infection Control Education for Major Sports, LLC. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States

Affiliations

Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States

Authors

Affiliations

Abstract

Conflict of interest statement

Grants and funding

LinkOut - more resources

Full Text Sources