1 Center for Acute Care Outcomes, Children's Minnesota Research Institute, Minneapolis, Minnesota.
2 Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.
Ann Am Thorac Soc. 2017 Nov;14(11):1655-1661. doi: 10.1513/AnnalsATS.201611-860OC.
Nontuberculous mycobacteria are an important cause of morbidity in the United States, although patient outcomes vary greatly by species. Currently, nationally representative data on the distribution of mycobacterial species from clinical isolates are limited.
Using a national hospitalization database capturing microbiologic data for nearly 6 million patient encounters, we describe the geographic distribution of, and patient demographic features associated with, clinical mycobacterial isolates in the United States.
Linked demographic and microbiologic data from the Premier Healthcare Database were extracted for all patient encounters from 2009 to 2013. Patients with at least one positive potentially pathogenic nontuberculous mycobacterial culture were identified as cases. The period prevalence was calculated, and patient-, encounter-, and hospital-level factors were analyzed. Regional differences in species distribution were analyzed; a subanalysis was conducted among patients with International Classification of Diseases, Ninth Revision, codes for pulmonary nontuberculous mycobacterial disease. Significant differences were assessed (P < 0.05).
Of 5,928,830 unique patients included during the 5-year study period, 7,812 (0.13%) had at least one positive nontuberculous mycobacterial culture. The mean age of cases was 64 years (range, <1-89 yr), and most were female (52%) and white (70%). Hospitals with cases were more often labeled "urban" (96%), "teaching" (56%), and had at least 500 beds (78%). Species distribution differed significantly by geographic area. Mycobacterium avium complex ranged from 61 to 91% of isolates and were most frequent in the South and Northeast regions; M. abscessus/M. chelonae ranged from 2 to 18% of isolates and were most frequent in the West; and other species, including M. fortuitum and M. kansasii, ranged from 7 to 26% and were also most frequent in the West.
Significant geographic variation exists in the distribution of nontuberculous mycobacterial species in the United States. Whereas M. avium complex was the most common species isolated in the South, M. abscessus/M. chelonae was proportionately higher in the West. Greater clinical awareness in regions with increased levels of harder-to-treat mycobacteria are needed, given differences in treatment options and implications for patient outcomes.
非结核分枝杆菌是美国发病率的一个重要原因，尽管患者的结局因物种的不同而有很大的差异。目前，从临床分离株获得的分枝杆菌物种的全国代表性数据有限。
利用一个全国性的住院数据库，该数据库捕获了近 600 万次患者就诊的微生物数据，我们描述了美国临床分枝杆菌分离株的地理分布情况，以及与患者人口统计学特征相关的情况。
从 2009 年至 2013 年，从 Premier Healthcare Database 中提取了与人口统计学和微生物学相关的数据。至少有一次阳性潜在致病性非结核分枝杆菌培养阳性的患者被确定为病例。计算了期间的患病率，并分析了患者、就诊和医院的相关因素。分析了物种分布的区域差异；对国际疾病分类，第九版代码为肺非结核分枝杆菌病的患者进行了亚分析。评估了显著差异（P<0.05）。
在 5 年的研究期间，共有 5928830 名独特的患者，其中 7812 名（0.13%）至少有一次非结核分枝杆菌培养阳性。病例的平均年龄为 64 岁（范围为<1-89 岁），大多数为女性（52%）和白人（70%）。有病例的医院更常被标记为“城市”（96%）、“教学”（56%）和至少有 500 张床位（78%）。物种分布在地理区域上有显著差异。鸟分枝杆菌复合体占分离株的 61%至 91%，在南部和东北部地区最为常见；脓肿分枝杆菌/chelonae 占分离株的 2%至 18%，在西部地区最为常见；其他物种，包括偶然分枝杆菌和堪萨斯分枝杆菌，占分离株的 7%至 26%，在西部地区也最为常见。
在美国，非结核分枝杆菌的分布存在显著的地域差异。在南部，鸟分枝杆菌复合体是最常见的分离株，而在西部，脓肿分枝杆菌/chelonae 的比例更高。鉴于治疗选择和对患者结局的影响不同，需要在硬治疗分枝杆菌水平较高的地区提高临床认识。
