Clinical Presentation, Microbiological Profile, Treatment Outcome, and Predictors of Outcome in Patients with...

Nontuberculous mycobacteria (NTM) are ubiquitous organisms with varied clinical syndromes. We conducted this study to identify the clinical spectrum, microbiological diagnosis, outcomes, and predictors of outcome in patients with NTM bloodstream infections (NTM BSIs).

This is a retrospective study of patients diagnosed with NTM BSI from January 2005 to December 2024. Poor outcomes were defined as patients who either expired or were lost to follow-up after being discharged against medical advice, subsequent to a poor prognosis.

A total of 40 patients with NTM BSI were included. The median age was 43 years with male predominance (n = 25, 62.5%). Associated risk factors included human immunodeficiency virus (HIV) infection (n = 18, 45%) with a median CD4 count of 18 cells/mm3, diabetes mellitus (n = 7, 31.8%), and immunosuppressive medication use (n = 6, 27.3%). The spectrum of infections among HIV-negative patients (n = 22) were disseminated infection (n = 6), coronary stent infection (n = 5), infective endocarditis (n = 4), catheter-related BSI (n = 4), pacemaker lead infection (n = 1), aortic stent infection (n = 1), thecoperitoneal shunt infection (n = 1), and infected bedsore (n = 1). All HIV-positive patients presented with disseminated NTM infection. Poor outcome for NTM BSI was seen in 64.9% of patients. Among the rapid growers, Mycobacterium abscessus complex had the worst prognosis with a poor outcome in 71.4% of patients.

The spectrum of diseases associated with NTM BSI was either disseminated disease in an immunosuppressed host or infection secondary to nosocomial contamination of a catheter, implant, or stent. NTM BSI is associated with poor prognosis. This underscores the need for early diagnosis, appropriate antibiotic therapy, and adequate source control to improve clinical outcomes.