Non-Tuberculous Mycobacteria Bloodstream Infection in Pediatric and Adult Patients, Fifteen Years Surveillance
2Infectious Diseases Unit, Rambam Health Care Campus
3Microbiology Laboratory, Rambam Health Care Campus, ישראל
Background: Nontuberculous Mycobacteria (NTM) are a rare cause of bloodstream infection (BSI). We aimed to evaluate the clinical characteristics, treatment and outcomes of NTM BSI in children and adults.
Methods: We retrospectively reviewed the charts of patients with NTM BSI, from January 1st, 2005 through June 30th, 2020. Data on demographics, underlying conditions, clinical manifestation, NTM species, treatment and outcome were retrieved.
Results: Positive blood cultures for NTM were detected in 43 patients, 30 children and 13 adults. Median age 10.37(IQR 6.692-39.864). Male to Female ratio was 1.263, thirty-seven (86%) patients had active malignant disease, 3(7%) had intestinal failure and central venous catheter (CVC). Fever was the chief sign in 23(53.5%) patients, pulmonary manifestation in 14(32.6%) and skin manifestation in 2(4.7%). Rapidly growing NTM comprised 39(90.7%) of the isolates; M. mucogenicum in 14(32.6%), M. fortuitum 11(25.6%), M. phocaicum 9(20.9%). Indwelling CVC during bacteremia was documented in 39(90.7%) cases, of whom 31(79.5%) were removed as a part of treatment. Antibiotic treatment directed against NTM was documented in 26(60.5%) patients. CVC was removed in 7/17 of untreated patients. Relapse occurred in three cases and no 30-days mortality was reported. Children and adults had similar clinical characteristics. However, children had a higher rate of CVC at the time of bacteremia and a higher chance to get treatment.
Conclusion: NTM SBI usually affects oncological patients with CVC. Half may be afebrile. Children and adults had a similar disease course and outcome. CVC removal is strongly recommended. Relapse was rare. NTM-related mortality was not reported.