Review of the Canadian Nontuberculous Mycobacterial Disease Landscape-Challenges and Opportunities

The incidence and prevalence of nontuberculous mycobacterial (NTM) disease are rising. This narrative review examines the evolution of NTM disease trends over the past four decades, in Canada and globally, encompassing changing epidemiology, shifting treatment paradigms, and emerging antimicrobial resistance patterns. Challenges to NTM treatment are explored, and novel and investigational therapies are summarized. Key themes include a significant increase in NTM disease incidence, temporal shifts in the dominant species causing human infections, evolution from single-drug to multi-drug treatment approaches, and growing concerns regarding macrolide resistance. The substantial challenges with treatment tolerability, effectiveness, and access are outlined. This review synthesizes data from multiple sources, including peer-reviewed literature, clinical trials, and public health databases, to provide a comprehensive understanding of the changing NTM disease landscape in Canada and more broadly. There is a need for expanded surveillance, continued innovation, and a multidisciplinary approach to NTM management.