NON-TUBERCULOUS MYCOBACTERIAL (NTM) INFECTIONS ISOLATED FROM BIRMINGHAM HEARTLANDS HOSPITAL: A CASE NOTES REVIEW. K. Clay 1 , K. Bhatt 1 , D. Burns 1 , J. Evans 2 , S. Gardiner 2 , EG. Smith 2 , P. Hawkey 2 , E. Moran 1 , M. Dedicoat 1 Department of Infection and Tropical Medicine 1 Birmingham Heartlands Hospital Public Health England, Public Health Laboratory Birmingham 2
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NON-TUBERCULOUS MYCOBACTERIAL
(NTM) INFECTIONS ISOLATED FROM
BIRMINGHAM HEARTLANDS HOSPITAL:
A CASE NOTES REVIEW.
K. Clay1, K. Bhatt1, D. Burns1, J. Evans2, S. Gardiner2,
EG. Smith2, P. Hawkey2, E. Moran1, M. Dedicoat1
Department of Infection and Tropical Medicine1
Birmingham Heartlands Hospital
Public Health England, Public Health Laboratory Birmingham2
Background
• 120 species (15 pathogenic)
• NTM mostly found in patients with underlying lung disease
or immune suppression
• Improving diagnostics (Watterson et al, 2000)
• Limited evidence
• Uncertain clinical significance
• NTM clinic
Moore et al. BMC Public Health 2010, 10:612
Figure 1 Rates of non-tuberculous mycobacteria reports (selected species), England, Wales and Northern Ireland, 1995-2006.
Rates of NTM increasing (England, Wales, N. Ireland)
0.9/100,000 in 1995 to 2.9/100,000 in 2006 (Moore et al, 2010)
Aims
• To review the annual rate of NTM infections within the
Heart of England Foundation Trust isolated at the PHE
regional mycobacterial laboratory from 2000 – 2010
• To perform a case notes review of patients with an
isolated NTM infection from 2008 - 2010
Method
• Mycobacterial reference laboratory at Birmingham
Heartlands Hospital (BHH)
• Database of all NTM infections
• Data collected from 2000 – 2010 for patients within the
Heartlands Trust
• Further review of online clinical records from 2008 to 2010
• Exclusion criteria
• Duplicate samples from the same patient within that year
• Patients from outside of the Heart of England NHS Foundation
Trust
Method
• Data collected
• Demographics
• NTM infection isolated
• Source of isolate
• Whether the infections was considered clinically relevant
• Criteria – as per American Thoracic Society (ATS) guidelines
• Treatment including planned duration
• Treatment toxicities
• Mortality
• Background medical conditions
• Lung disease/immunosuppression
• Smoking history
ATS guidelines 2007
• Significant results based on;
• Clinical significance
• Pulmonary symptoms
+ CXR – nodular/cavitatory changes
or HRCT – multifocal bronchiectasis + multinodular changes
• Regional cystic fibrosis unit changes our population at risk
Summary
• NTM rates increasing
• Gender differences
• M.TB versus NTM
• MAC most common infection
• M.abscessus 2nd most common
• Low incidence of M.kansasii
• Strong association with immune suppression and lung
disease
• Minimal isolates in HIV positive patients
• Increased laboratory workload
• NTM clinic
References
Public Health England, Public Health Laboratory Birmingham - standard operating procedures
UK Standards for Microbiology Investigations. Investigations of Specimens for Mycobacterium species. PHE guidelines.
British Thoracic Society. Management of opportunist mycobacterial infections: Joint Tuberculosis Committee guidelines 1999
American Thoracic Society. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. 2007
Moore J, Kruijshaar M, Ormerod P et al. Increasing reports of non-tuberculous mycobacteria in England, Wales and Northern Ireland, 1995-2006. BMC Public Health 2010, 10;612
Watterson S, Drobniewski F. Modern laboratory diagnosis of mycobacterial infections. J Clin Pathol 2000 53: 727-732