title: Epidemiology of nontuberculous mycobacteria among patients with cystic fibrosis in Scandinavia.
abstract: BACKGROUND
  Nontuberculous mycobacteria (NTM) are an emerging threat to cystic fibrosis (CF) patients but their epidemiology is not well described.
  
  
  METHODS
  In this retrospective observational study we identified all Scandinavian CF patients with a positive NTM culture from airway secretions from 2000 to the end of 2012 and used national CF databases to describe microbiological and clinical characteristics.
  
  
  RESULTS
  During the 13-year period 157 (11%) CF patients were culture positive for NTM at least once. Mycobacterium abscessus complex (MABSC) (45%) and Mycobacterium avium complex (MAC) (32%) were the predominant species with geographical differences in distribution. Younger patients were more prone to MABSC (p<0.01). Despite treatment, less than one-third of MABSC patients with repeated positive cultures cleared their infection and a quarter had a lung transplant or died.
  
  
  CONCLUSIONS
  NTM are significant CF pathogens and are becoming more prevalent in Scandinavia. MABSC and MAC appear to target distinct patient groups. Having multiple positive cultures despite treatment conveys a poor outcome.
authors.affiliation: Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark. Electronic address: tavs.qvist@gmail.com.
authors.forename: Tavs
authors.initials: T
authors.lastname: Qvist
authors.affiliation: Gothenburg CF Center, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Marita
authors.initials: M
authors.lastname: Gilljam
authors.affiliation: Clinical Microbiology Laboratories, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Jönsson
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: David
authors.initials: D
authors.lastname: Taylor-Robinson
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Jensen-Fangel
authors.affiliation: Department of Clinical Microbiology, Aarhus University Hospital, Denmark.
authors.forename: Mikala
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden.
authors.forename: Anita
authors.initials: A
authors.lastname: Svahn
authors.affiliation: Gothenburg CF Center, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karsten
authors.initials: K
authors.lastname: Kötz
authors.affiliation: Lund CF Center, Department of Respiratory Medicine and Allergology, Skane University Hospital, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Hansson
authors.affiliation: Uppsala CF center, KBH, Uppsala University Hospital, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Hollsing
authors.affiliation: Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Christine R
authors.initials: CR
authors.lastname: Hansen
authors.affiliation: Norwegian Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway.
authors.forename: Pål L
authors.initials: PL
authors.lastname: Finstad
authors.affiliation: Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark.
authors.forename: Tania
authors.initials: T
authors.lastname: Pressler
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Høiby
authors.affiliation: Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark.
authors.forename: Terese L
authors.initials: TL
authors.lastname: Katzenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000453:epidemiology*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D015995:Prevalence; D012189:Retrospective Studies; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D055815:Young Adult
keywords: Mycobacterium abscessus; Mycobacterium avium; Prevalence; Susceptibility