title: Household proximity to water and nontuberculous mycobacteria in children with cystic fibrosis.
abstract: Nontuberculous mycobacteria (NTM) have a particular affinity for patients with cystic fibrosis (CF). Recent studies suggest a possible relationship between acquiring NTM and the level of environmental water in a given area. We sought to determine if there is an association between household proximity to water and NTM in children with CF.
  
  
  
  An IRB-approved retrospective chart review was completed on 150 children with CF in Florida. Inclusion criteria required regular follow-up, at least two acid-fast bacilli cultures, and a consistent home address over a 3-year period. The distance from each patient's home to the nearest body of water was measured using ArcMap®, a Geographic Information System, and the mean distance to water for NTM-positive and NTM-negative groups were compared. A stepwise backwards logistic regression was used to evaluate for predictors of NTM-positivity.
  
  
  
  Of the 150 CF patients, 65 met inclusion criteria and 21 (32.3%) tested positive for NTM. Comparison of the mean distance to water for NTM-positive versus NTM-negative groups revealed a cutoff of 500 meters. On the logistic regression, CF patients who lived within 500 meters of water were 9.4 times more likely to acquire NTM (P = 0.013). Other significant predictors included a history of Aspergillus fumigatus (OR 7.9, P = 0.011) and recent history of Pseudomonas aeruginosa (OR 2.5, P = 0.007).
  
  
  
  In the regions studied, children with CF who live closer to water are more likely to acquire nontuberculous mycobacteria. Future studies in other geographic areas are needed to determine if these results are generalizable. Pediatr Pulmonol. 2017;52:324-330. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Pediatric Residency Program at Sacred Heart Hospital, University of Florida, Pensacola, Florida.|Department of Pediatric Pulmonology, Nemours Children's Specialty Care, Pensacola, Florida.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bouso
authors.affiliation: Pediatric Residency Program at Sacred Heart Hospital, University of Florida, Pensacola, Florida.
authors.forename: James J
authors.initials: JJ
authors.lastname: Burns
authors.affiliation: Department of Mathematics and Statistics, University of West Florida, Pensacola, Florida.
authors.forename: Raid
authors.initials: R
authors.lastname: Amin
authors.affiliation: Department of Pediatric Pulmonology, Nemours Children's Specialty Care, Orlando, Florida.
authors.forename: Floyd R
authors.initials: FR
authors.lastname: Livingston
authors.affiliation: Pediatric Residency Program at Sacred Heart Hospital, University of Florida, Pensacola, Florida.|Department of Pediatric Pulmonology, Nemours Children's Specialty Care, Pensacola, Florida.
authors.forename: Okan
authors.initials: O
authors.lastname: Elidemir
mesh_terms: D000293:Adolescent; D000407:Alabama; D001228:Aspergillosis / Q000453:epidemiology; D001232:Aspergillus fumigatus; D002648:Child; D003550:Cystic Fibrosis / Q000382:microbiology*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005618:Fresh Water; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology*; D009170:Nontuberculous Mycobacteria; D009792:Oceans and Seas; D011552:Pseudomonas Infections / Q000453:epidemiology; D011550:Pseudomonas aeruginosa; D012111:Residence Characteristics; D012189:Retrospective Studies
keywords: atypical mycobacteria; children; cystic fibrosis; infections (pneumonia TB viral); infectious disease; nontuberculous mycobacteria; pediatric pulmonology; water