title: Identification of non-tuberculous mycobacteria isolated from clinical specimens at a tertiary care hospital: a cross-sectional study.
abstract: BACKGROUND
  Non-tuberculous mycobacteria (NTM) are opportunistic pathogens in immuno-compromised patients. They are also increasingly recognized as pathogens in immuno-competent individuals. Globally, an increase in NTM isolation is being reported with a varied geographic prevalence of different species around the world. There is lack of data on species distribution of these organisms from Pakistan. Treatment options differ according to the species isolated and its susceptibility profile. Knowledge of local species variation would help targeted therapy. This study was performed to determine frequencies of different NTM species isolated from various clinical specimens submitted at a tertiary care hospital laboratory.
  
  
  METHODS
  NTM isolated from 25955 clinical specimens over a period of two years (2010 to 2011) were included. All NTM were identified using conventional tests. Drug susceptibility testing (DST) was performed by broth microdilution and interpreted according to Clinical and Laboratory Standards Institute's document M24-A2.
  
  
  RESULTS
  A total of 104 NTM were included in the study. Of these, 76% (54/71) rapidly growing mycobacteria (RGM) and 57.6% (19/33) slow growing mycobacteria (SGM) could be further identified. Mycobacterium fortuitum (21/54) was the commonest NTM identified among RGM followed by M. mucogenicum (12/54) and M. smegmatis (11/54). Among SGM, M. avium complex (MAC) was the most frequent (14/19). Clinical significance could be assessed in a limited number (52/104) of NTM isolates and MAC appeared to be the commonest significant NTM. Three extra-pulmonary cases were found to be healthcare associated infections. DST results for RGM showed susceptibility to amikacin (100%), clarithromycin (100%, except M. fortuitum where it is not reportable), linezolid (90%) and moxifloxacin (75%). Whereas SGM were susceptible to clarithromycin (100%), linezolid (58.8%) and moxifloxacin (64.7%).
  
  
  CONCLUSIONS
  This is the first study reporting NTM species and their clinical significance isolated from clinical specimens from Pakistan. Isolation of NTM from clinical specimens should prompt to evaluate their clinical significance.
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmed
authors.forename: Kauser
authors.initials: K
authors.lastname: Jabeen
authors.affiliation: Department of Pathology & Microbiology, Aga Khan University Hospital, Karachi, Pakistan. rumina.hasan@aku.edu.
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003430:Cross-Sectional Studies; D062306:Geography, Medical; D006801:Humans; D008826:Microbial Sensitivity Tests; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D010154:Pakistan / Q000453:epidemiology; D063128:Tertiary Health Care
chemical_list: D000900:Anti-Bacterial Agents