Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline

Charles L Daley; Jonathan M Iaccarino; Christoph Lange; Emmanuelle Cambau; Richard J Wallace; Claire Andrejak; Erik C Böttger; Jan Brozek; David E Griffith; Lorenzo Guglielmetti; Gwen A Huitt; Shandra L Knight; Philip Leitman; Theodore K Marras; Kenneth N Olivier; Miguel Santin; Jason E Stout; Enrico Tortoli; Jakko van Ingen; Dirk Wagner; Kevin L Winthrop

doi:10.1093/cid/ciaa1125

Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline

Clin Infect Dis. 2020 Aug 14;71(4):905-913. doi: 10.1093/cid/ciaa1125.

Authors

Charles L Daley^{1

2}, Jonathan M Iaccarino³, Christoph Lange^{4

5

6

7}, Emmanuelle Cambau⁸, Richard J Wallace⁹, Claire Andrejak^{10

11}, Erik C Böttger¹², Jan Brozek¹³, David E Griffith¹⁴, Lorenzo Guglielmetti^{8

15}, Gwen A Huitt^{1

2}, Shandra L Knight¹⁶, Philip Leitman¹⁷, Theodore K Marras¹⁸, Kenneth N Olivier¹⁹, Miguel Santin²⁰, Jason E Stout²¹, Enrico Tortoli²², Jakko van Ingen²³, Dirk Wagner²⁴, Kevin L Winthrop²⁵

Affiliations

¹ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
² Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
³ Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA.
⁴ Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
⁵ German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany.
⁶ Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany.
⁷ Department of Medicine, Karolinska Institute, Stockholm, Sweden.
⁸ National Reference Center for Mycobacteria and Antimycobacterial Resistance, APHP -Hôpital Lariboisière, Bacteriology; Inserm, University Paris Diderot, IAME UMR1137, Paris, France.
⁹ Mycobacteria/Nocardia Laboratory, Department of Microbiology, The University of Texas Health Science Center, Tyler, Texas, USA.
¹⁰ Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France.
¹¹ EA 4294, AGIR, Jules Verne Picardy University, Amiens, France.
¹² Institute of Medical Microbiology, National Reference Center for Mycobacteria, University of Zurich, Zurich, Switzerland.
¹³ Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada.
¹⁴ Pulmonary Infectious Disease Section, University of Texas Health Science Center, Tyler, Texas, USA.
¹⁵ Team E13 (Bactériologie), Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Université Pierre et Marie Curie, Université Paris 06, Centre de Recherche 7, INSERM, IAME UMR1137, Paris, France.
¹⁶ Library and Knowledge Services, National Jewish Health, Denver, Colorado, USA.
¹⁷ NTM Info & Research, Miami, Florida, USA.
¹⁸ Department of Medicine, University of Toronto and University Health Network, Toronto, Ontario, Canada.
¹⁹ Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA.
²⁰ Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
²¹ Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA.
²² Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
²³ Radboud Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁴ Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
²⁵ Divisions of Infectious Diseases, Schools of Public Health and Medicine, Oregon Health and Science University, Portland, Oregon, USA.

Abstract

Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.

Keywords: Mycobacterium abscessus; Mycobacterium avium complex; Mycobacterium kansasii; Mycobacterium xenopi; nontuberculous.

Publication types

Practice Guideline

MeSH terms

Adult
Humans
Mycobacterium Infections, Nontuberculous* / diagnosis
Mycobacterium Infections, Nontuberculous* / drug therapy
Mycobacterium abscessus*
Mycobacterium avium Complex
Mycobacterium kansasii*
Nontuberculous Mycobacteria