The New Zealand medical journal · 2026
The management of patients with positive non-tuberculous mycobacterium cultures at a local centre in New Zealand-a retrospective study.
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Xian Susan Y, Nanguzgambo Aldoph
Аннотация
AIM: We aimed to assess whether management of patients with positive non-tuberculous mycobacterium (NTM) cultures at Palmerston North Hospital aligns with international guidelines.
METHOD: We conducted a retrospective study of adult patients with positive mycobacterial cultures between 1 December 2020 and 1 December 2022 in the MidCentral Region. Electronic records were reviewed for microbiological sampling, radiological assessment, treatment decisions, monitoring and outcomes. Management was compared with the 2017 British Thoracic Society and 2020 American Thoracic Society/Infectious Diseases Society of America guidelines.
RESULTS: Fifty-four adult patients were included. Thirty-two (59%) met microbiological criteria for NTM pulmonary disease, and 22 (41%) met full diagnostic criteria. Fifty (93%) had at least two sputum samples sent, with 43 (80%) of these sent on separate days. The median number of days from sputum positivity to computed tomography (CT) was 63 days. Of those that met diagnostic criteria, 13 patients were offered treatment, 11 commenced therapy and five achieved culture conversion. Ten patients discontinued therapy. Reasons for treatment cessation were multifactorial and included persistent culture positivity, medication intolerance, medication interactions and radiographic improvement. Surveillance sputum monitoring during treatment was documented in 64% of cases. Sensitivity testing was performed in 40% of those who were treated for Mycobacterium avium. Treatment duration was variable with a median duration of 762 days.
CONCLUSION: Management was broadly consistent with international guidelines. Improvements are needed in microbiological sampling completeness, sensitivity testing, timely CT imaging and treatment monitoring. These findings highlight opportunities to standardise NTM diagnostic and follow-up pathways in a regional New Zealand centre.
METHOD: We conducted a retrospective study of adult patients with positive mycobacterial cultures between 1 December 2020 and 1 December 2022 in the MidCentral Region. Electronic records were reviewed for microbiological sampling, radiological assessment, treatment decisions, monitoring and outcomes. Management was compared with the 2017 British Thoracic Society and 2020 American Thoracic Society/Infectious Diseases Society of America guidelines.
RESULTS: Fifty-four adult patients were included. Thirty-two (59%) met microbiological criteria for NTM pulmonary disease, and 22 (41%) met full diagnostic criteria. Fifty (93%) had at least two sputum samples sent, with 43 (80%) of these sent on separate days. The median number of days from sputum positivity to computed tomography (CT) was 63 days. Of those that met diagnostic criteria, 13 patients were offered treatment, 11 commenced therapy and five achieved culture conversion. Ten patients discontinued therapy. Reasons for treatment cessation were multifactorial and included persistent culture positivity, medication intolerance, medication interactions and radiographic improvement. Surveillance sputum monitoring during treatment was documented in 64% of cases. Sensitivity testing was performed in 40% of those who were treated for Mycobacterium avium. Treatment duration was variable with a median duration of 762 days.
CONCLUSION: Management was broadly consistent with international guidelines. Improvements are needed in microbiological sampling completeness, sensitivity testing, timely CT imaging and treatment monitoring. These findings highlight opportunities to standardise NTM diagnostic and follow-up pathways in a regional New Zealand centre.