EPIDEMIOLOGY OF NONTUBERCULOUS MYCOBACTERIUM FROM AN INNER-CITY PHILADELPHIA HOSPITAL IN PATIENTS WITHOUT HIV

Abstract

SESSION TITLE: Chest Infections 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Nontuberculous mycobacterium (NTM) are free-living organisms that are ubiquitous in the environment, however the importance of NTM disease in humans is increasingly evident. As NTM is a non-reportable disease and as environmental exposure is dependent on geographical areas, the incidence and risk factors of NTM in our area are ill-defined. This study is to help us determine the incidence of NTM in inner Philadelphia in those without HIV infection, the risk factors which lead to disease and the speciation related to the different diseases. METHODS: We conducted a retrospective study of patients without known HIV infection who had an AFB culture positive from 2016 to 2017. Patients with blood cultures or tissue biopsy positive for NTM were concluded to have disease; respiratory disease was considered if they met ATS guidelines: 1. chest radiograph or, in the absence of cavitations, chest high-resolution computed tomography; 2. Positive cultures from sputum samples or one bronchial wash; and 3. Exclusion of other disorders, such as TB. The data was collected from cultures at Hahnemann University Hospital in Philadelphia. This was an IRB study. RESULTS: From 2016-2017, there were 87 total patients who were identified to have NTM positive cultures, of which 61 were in patients who were not infected with HIV, of those 42 were identified to have an active NTM infection. Demographics include: average age 57, 27 males and 15 females, and 20 White, 14 Black, 5 Asian and 3 Hispanic patients. Out of the 42 infections, there were 36 respiratory infections, 3 positive tissue cultures, 2 positive blood cultures and 1 urinary culture. Species identified included 33 cultures positive for MAC, 4 cultures M. abscessus, 3 cultures M. bolletii, 2 cultures each of M. chelonae and M. kansasii, and 1 culture each for M. xenoxpix and M. szulgai. Coexisting medical illnesses included 24 with underlying lung disease, 6 patients immunocompromised, 4 patients with cancer, 3 transplant patients and 6 with no underlying medical illness. There were 3 patients on immunosuppressants, 2 on steroids, 1 on chemotherapy and 1 on an immunomodulator. There were patients who occasionally had >1 NTM in the AFB culture, more than one source of culture positivity or more than one underlying medical co-illness. CONCLUSIONS: Although MAC was shown to be the most prevalent in the community, 31% of cultures grew disease causing NTM species other than MAC with the next most common being M. abscessus and M. bolletii. It is important to note that in those with underlying lung disease, various species of NTM can be attributed to disease and should be treated. CLINICAL IMPLICATIONS: This small study gives us an insight into the types of infections and the speciation of those with disease that is prevalent in this community. Although MAC being the most common, patients with other infectious NTM species should be considered for treatment also. DISCLOSURES: No relevant relationships by Janpreet Mokha, source=Web Response No relevant relationships by Ekamjeet Randhawa, source=Web Response No relevant relationships by Michael Stephen, source=Web Response