title: Nontuberculous mycobacteria: the changing epidemiology and treatment challenges in cystic fibrosis.
abstract: OBJECTIVE
  Although patients with cystic fibrosis (CF) face numerous infectious pathogens over the course of their lifespan, increasing attention has recently been paid to nontuberculous mycobacteria (NTM). As reported prevalence rates rise across many countries such as the United States, the ability to recognize disease caused by NTM and subsequently treat such disease has become increasingly important. This review summarizes new observations on the epidemiology of NTM in CF as well as key elements to consider during the treatment phase.
  
  
  RESULTS
  Although overall rates of NTM isolation appear to be increasing, particular concern has focused on the emerging predominance of Mycobacterium abscessus. New data suggest that chronic macrolide therapy now part of routine CF care has contributed to this rise; however, these have yet to be confirmed prospectively. Transmission of M. abscessus between CF patients has also now been described through the use of genome sequencing. Although the greater virulence of M. abscessus makes it a challenging species to treat, identification of the subspecies type can now determine the presence of inducible macrolide resistance, thereby helping to guide treatment.
  
  
  CONCLUSIONS
  Given increasing prevalence rates, clinicians should maintain a high level of suspicion for NTM as disease-causing organisms in CF, particularly for M. abscessus. New knowledge regarding this species, however, can help to tailor appropriate therapy.
authors.affiliation: aCritical Care Medicine Department, Clinical Center bLaboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Leung
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Olivier
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D015995:Prevalence; D013183:Sputum / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides
references.citation: Med Microbiol Immunol. 2004 Nov;193(4):209-17
references.pmid: 12955501
references.citation: Eur Respir J. 2000 Oct;16(4):749-67
references.pmid: 11106223
references.citation: Pediatr Pulmonol. 2009 Nov;44(11):1100-6
references.pmid: 19830845
references.citation: J Appl Microbiol. 2009 Aug;107(2):356-67
references.pmid: 19228258
references.citation: J Korean Med Sci. 2008 Jun;23(3):397-401
references.pmid: 18583873
references.citation: J Clin Microbiol. 2012 Nov;50(11):3556-61
references.pmid: 22915613
references.citation: J Heart Lung Transplant. 2006 Aug;25(8):985-8
references.pmid: 16890122
references.citation: Acta Paediatr Scand. 1988 Jul;77(4):569-75
references.pmid: 3394511
references.citation: Antimicrob Agents Chemother. 2004 Dec;48(12):4562-5
references.pmid: 15561826
references.citation: Drug Saf. 1999 Aug;21(2):137-52
references.pmid: 10456381
references.citation: Am J Respir Crit Care Med. 2011 Feb 1;183(3):405-10
references.pmid: 20833823
references.citation: Clin Pharmacokinet. 1998 Oct;35(4):313-29
references.pmid: 9812180
references.citation: J Clin Microbiol. 2009 Dec;47(12):4124-8
references.pmid: 19846643
references.citation: Lancet. 2013 May 4;381(9877):1551-60
references.pmid: 23541540
references.citation: Am J Respir Crit Care Med. 2012 Nov 1;186(9):917-25
references.pmid: 22878281
references.citation: J Clin Microbiol. 2005 Jul;43(7):3467-70
references.pmid: 16000480
references.citation: Am J Respir Crit Care Med. 2003 Mar 15;167(6):828-34
references.pmid: 12433668
references.citation: Lancet. 2006 Jun 10;367(9526):1952
references.pmid: 16765765
references.citation: Chest. 1993 Apr;103(4):1096-9
references.pmid: 8131446
references.citation: Eur Respir J. 1999 Aug;14(2):347-51
references.pmid: 10515412
references.citation: Curr Opin Infect Dis. 2012 Apr;25(2):193-8
references.pmid: 22123666
references.citation: Am J Infect Control. 2003 May;31(3 Suppl):S1-62
references.pmid: 12762292
references.citation: JAMA. 2003 Oct 1;290(13):1749-56
references.pmid: 14519709
references.citation: J Bacteriol. 2012 Oct;194(19):5450
references.pmid: 22965080
references.citation: Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416
references.pmid: 17277290
references.citation: Med J Aust. 2011 Oct 3;195(7):392-5
references.pmid: 21978346
references.citation: Lancet. 2002 Sep 28;360(9338):978-84
references.pmid: 12383667
references.citation: Int J Syst Evol Microbiol. 2006 Jan;56(Pt 1):133-43
references.pmid: 16403878
references.citation: Emerg Infect Dis. 2003 Dec;9(12):1587-91
references.pmid: 14720400
references.citation: Clin Infect Dis. 2001 May 1;32(9):1298-303
references.pmid: 11303264
references.citation: J Pediatr Surg. 1983 Dec;18(6):811-5
references.pmid: 6663409
references.citation: Cochrane Database Syst Rev. 2012 Nov 14;11:CD002203
references.pmid: 23152214
references.citation: J Cyst Fibros. 2009 Dec;8(6):386-91
references.pmid: 19740710
references.citation: Clin Pharmacokinet. 1987 Oct;13(4):228-53
references.pmid: 3311531
references.citation: Arch Dis Child. 1996 May;74(5):449-51
references.pmid: 8669964
references.citation: Acta Paediatr. 2003 Aug;92(8):910-5
references.pmid: 12948065
references.citation: J Pediatr Surg. 1991 Jun;26(6):655-9
references.pmid: 1941450
references.citation: Thorax. 1998 Mar;53(3):182-5
references.pmid: 9659352
references.citation: Am J Respir Crit Care Med. 2007 Nov 15;176(10):957-69
references.pmid: 17761616
references.citation: JAMA. 1970 Jul 6;213(1):125-7
references.pmid: 5467962
references.citation: Clin Infect Dis. 2001 Jun 1;32(11):1648-50
references.pmid: 11340540
references.citation: Ann Thorac Surg. 1998 Aug;66(2):325-30
references.pmid: 9725364
references.citation: Pediatr Pulmonol. 2005 Jul;40(1):39-44
references.pmid: 15858802
references.citation: J Cyst Fibros. 2012 Jul;11(4):340-3
references.pmid: 22342403
references.citation: J Pediatr. 1986 May;108(5 Pt 2):847-53
references.pmid: 3517272
references.citation: J Cyst Fibros. 2010 Jul;9(4):272-6
references.pmid: 20400381
references.citation: Pediatr Pulmonol. 2010 Jun;45(6):626-7
references.pmid: 20503290
references.citation: Am J Respir Crit Care Med. 2003 Mar 15;167(6):835-40
references.pmid: 12433669
references.citation: Antimicrob Agents Chemother. 2011 Feb;55(2):775-81
references.pmid: 21135185
references.citation: Eur Respir J. 2005 Feb;25(2):324-8
references.pmid: 15684298
references.citation: J Clin Microbiol. 2001 Feb;39(2):816-9
references.pmid: 11158161
references.citation: Med Mycol. 2010 Nov;48 Suppl 1:S32-6
references.pmid: 21067327
references.citation: Ann Thorac Surg. 2012 Apr;93(4):1033-9; discussion 1039-40
references.pmid: 22386091
references.citation: Thorax. 1984 May;39(5):369-75
references.pmid: 6429879
references.citation: J Cyst Fibros. 2010 Mar;9(2):117-23
references.pmid: 20071249
references.citation: BMC Pulm Med. 2007 Feb 23;7:2
references.pmid: 17319962
references.citation: J Pediatr. 1980 Apr;96(4):689-91
references.pmid: 7359275
references.citation: New Microbiol. 2007 Oct;30(4):411-4
references.pmid: 18080676
references.citation: Cochrane Database Syst Rev. 2012 Dec 12;12:CD010004
references.pmid: 23235684
references.citation: Pediatr Pulmonol. 2008 Jan;43(1):72-6
references.pmid: 18041083
references.citation: Chest. 1992 Jul;102(1):70-5
references.pmid: 1623799
references.citation: Curr Opin Infect Dis. 2010 Dec;23(6):578-83
references.pmid: 20847696
references.citation: Chest. 2009 Dec;136(6):1554-1560
references.pmid: 19505987
references.citation: J Antimicrob Chemother. 2012 Feb;67(2):290-8
references.pmid: 22020137
references.citation: BMC Infect Dis. 2011 May 05;11:113
references.pmid: 21545738
references.citation: BMJ. 2011 Feb 28;342:d1008
references.pmid: 21357627
references.citation: Am J Respir Crit Care Med. 2013 Oct 1;188(7):807-12
references.pmid: 23927602
references.citation: J Clin Invest. 2011 Sep;121(9):3554-63
references.pmid: 21804191
references.citation: Arch Bronconeumol. 2008 Dec;44(12):679-84
references.pmid: 19091237
references.citation: Thorax. 1990 May;45(5):397-400
references.pmid: 2382245
references.citation: Pediatr Pulmonol. 2000 Sep;30(3):267-8
references.pmid: 10973047
references.citation: Eur Respir J. 2013 May;41(5):1101-6
references.pmid: 22936714
references.citation: Emerg Infect Dis. 2008 Mar;14(3):378-84
references.pmid: 18325250
references.citation: Semin Respir Crit Care Med. 2003 Dec;24(6):693-702
references.pmid: 16088585
references.citation: Scand J Infect Dis. 1994;26(5):569-76
references.pmid: 7855554
references.citation: Pediatr Infect Dis J. 1997 Feb;16(2):257-9
references.pmid: 9041615
references.citation: Arch Dis Child. 1972 Dec;47(256):902-7
references.pmid: 4630477
references.citation: Pediatr Pulmonol. 2001 Nov;32(5):356-66
references.pmid: 11596160
references.citation: Eur J Cardiothorac Surg. 2011 Sep;40(3):671-5
references.pmid: 21324708
references.citation: Am J Respir Crit Care Med. 2003 Oct 15;168(8):918-51
references.pmid: 14555458
references.citation: J Clin Microbiol. 2004 Dec;42(12):5493-501
references.pmid: 15583272
references.citation: Microbiol Immunol. 2010 Jun;54(6):347-53
references.pmid: 20536733
references.citation: Pediatr Infect Dis J. 1989 Jun;8(6):393-6
references.pmid: 2748240
references.citation: J Clin Microbiol. 1993 Apr;31(4):861-4
references.pmid: 8463398
references.citation: Am J Respir Crit Care Med. 2005 Mar 15;171(6):621-6
references.pmid: 15591474
references.citation: Br J Dis Chest. 1984 Jul;78(3):299-302
references.pmid: 6743529
references.citation: Pediatr Infect Dis J. 1997 Apr;16(4):354-8
references.pmid: 9109135
references.citation: J Clin Microbiol. 2009 Jan;47(1):271-4
references.pmid: 19020061
references.citation: Transpl Infect Dis. 2009 Jun;11(3):243-8
references.pmid: 19298240
references.citation: Am J Respir Crit Care Med. 2012 Jan 15;185(2):231-2
references.pmid: 22246710
references.citation: Antimicrob Agents Chemother. 2003 May;47(5):1736-8
references.pmid: 12709349