title: US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis.
abstract: Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with pre-existing inflammatory lung disease such as cystic fibrosis (CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered 'good' agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition.
authors.affiliation: Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK.
authors.forename: R Andres
authors.identifier: http://orcid.org/0000-0002-2188-5659
authors.initials: RA
authors.lastname: Floto
authors.affiliation: Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA.
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Olivier
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, Pediatric Infectious Diseases, New York, New York, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.affiliation: Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
authors.affiliation: INSERM U1173, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France AP-HP, Service de Microbiologie, Hôpital Raymond Poincaré, Garches, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Herrmann
authors.affiliation: Department of Medicine, National Jewish Health, Denver, Colorado, USA.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Nick
authors.affiliation: The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Peadar G
authors.initials: PG
authors.lastname: Noone
authors.affiliation: Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Bilton
authors.affiliation: Department of Respiratory Medicine, Freeman Hospital, High Heaton, Newcastle, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Corris
authors.affiliation: Department of Pediatrics University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Gibson
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hempstead
authors.affiliation: Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karsten
authors.initials: K
authors.lastname: Koetz
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Sabadosa
authors.affiliation: Service de Pneumo-Pédiatrie, Université René Descartes, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sermet-Gaudelus
authors.affiliation: Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Smyth
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jakko
authors.initials: J
authors.lastname: van Ingen
authors.affiliation: Department of Microbiology, University of Texas Health Science Center, Tyler, Texas, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wallace
authors.affiliation: Oregon Health and Sciences University, Portland, Oregon, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Winthrop
authors.affiliation: Cystic Fibrosis Foundation, Bethesda, Maryland, USA.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Marshall
authors.affiliation: Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Haworth
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000150:complications*; D005060:Europe; D006801:Humans; D007275:Injections, Intravenous; D008403:Mass Screening; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacterial Infection; Cystic Fibrosis