Laboratory Diagnosis of Non-Tuberculous Mycobacterium Infections in Bronchiectasis Patients: Issues and Controversies

Non-tuberculous mycobacteria (NTM) are environmental microbes that can cause pulmonary infection and are especially problematic in bronchiectasis patients with or without cystic fibrosis (CF). Microbiological identification of NTM in these patients is difficult given the high microbial burden in the lungs and the need to differentiate between colonization and transient and true infection. Determining if and when to initiate antimicrobial treatment against this multi-drug-resistant group of organisms is also challenging. To address the changing landscape of care for these patients, the U.S. Cystic Fibrosis Foundation and the European Cystic Fibrosis Society convened an expert committee in 2016 and drafted new guidelines for the management of NTM in CF patients. These recommendations update the 2007 American Thoracic Society and Infectious Disease Society of America guidelines on the diagnosis and treatment of NTM pulmonary infections. Here, we provide data to support the new recommendations and discuss the advancements and ongoing challenges associated with NTM infections.