Nontuberculous Mycobacteria in Critical Care

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Recentstudies inpatients, who are hospitalized in Intensive Care Unit (ICU), show that 51% of them have infections, and 71% are given treatment. Bacterial and some fungal infections, as opportunistic microorganism are the primary concern. Hospitalizing in ICU is associated with increasing in mortality rate and excess expenses. Pharmacokinetics, absorption, distribution, metabolism, and excretion of drugs experience many changes in critical illness.

NTM, are a group of mycobacteria which is not a causative organism of tuberculosis or leprosy, so they called as Mycobacteria Other Than Tuberculosis (MOTT). NTM bacteria are a family of small, rod-shaped bacilli which have more than 150 species. Atypical mycobacteria have different favor in choosing their environment and are identified as environmental mycobacteria. NTM are the causative organisms in pulmonary diseases like tuberculosis, lymphadenitis, skin disease, or disseminated disease. Major clinical manifestations of NTM Infections are presented in Table 1. In 1950s, they were accepted as human pathogens. Unlike tuberculosis and leprosy, spreading NTM infections from one person to another person is rare. Environmental exposure is the major way of contagion. The risk of getting infected by a particular species of NTM is dependent on pathogenicity of microorganism, the method of exposure and frequency of exposure. In the last decade, (NTM) infections have worldwide increasing in incidence and mortality. The reasons for this increase are not obvious. But increasing incidence of acquired immune compromised syndrome, cancer, diabetes mellitus, chronic lung injuries, and continues supportive ventilation could be causative.

A retrospective study in medical center of Taiwan from January 1999 to June 2007 was planned to evaluate medical ICU patients whose respiratory specimens were positive for NTM. They defined tree group of patients, one group with NTM pulmonary infection, the other with NTM colonization and a control group who have culture negative samples for mycobacteria. Clinical sign, symptoms and outcomes were compared. Their finally result was that, increment in mortality rate in patients who have NTM pulmonary. Suitable treatment against NTM would followed by better result.