Extrapulmonary Nontuberculous Mycobacteria Infections in Hospitalized Patients

United States, 2009-2014

Emily E. Ricotta; Jennifer Adjemian; Rebekah A. Blakney; Yi Ling Lai; Sameer S. Kadri; D. Rebecca Prevots


Emerging Infectious Diseases. 2021;27(3):845-852. 

In This Article


The nationally distributed, hospital-based Cerner Health Facts EHR database (https://sc-ctsi.org/resources/cerner-health-facts) includes linked demographic, clinical, and microbiological information for ≈9 million US inpatients. Using this database, we identified all US patients hospitalized during 2009–2014 with positive NTM cultures from extrapulmonary sources (excluding M. gordonae because it is considered an environmental contaminant) (Appendix Table 1, https://wwwnc.cdc.gov/EID/article/27/3/20-1087-App1.pdf). Patients were classified as having SST disease, disseminated disease (including those with infections in blood, central nervous system, and sterile bone and joint sources), or both; patients with infections from abdominal sites, urinary system, or other body sites were also identified and grouped as other sources (Table 1; Appendix Tables 2, 3). Sources were further classified as sterile or not sterile and whether they were associated with a device, prosthesis, or surgical procedure (Table 2). We excluded from analysis 142 patients with isolates from unknown sources and 4,385 patients with isolates from pulmonary sources.

Patients with extrapulmonary NTM were described by demographic factors (age, sex, race, and geographic region) and clinical factors (underlying conditions and procedural history via codes from the International Classification of Diseases, Ninth and Tenth Revisions, and Current Procedural Terminology). To compare demographics by infection type, we used the Pearson χ 2 test or analysis of variance, where appropriate. We calculated overall and annual inpatient prevalence estimates by determining the number of unique inpatients with ≥1 positive extrapulmonary NTM culture divided by the total number of unique inpatients identified during the study period among hospitals reporting ≥1 case of extrapulmonary NTM. Patients whose cultures grew multiple NTM species or had isolates cultured from multiple extrapulmonary sites were counted in each group unless specified. Statistical analyses were conducted by using R version 4.0.2 (https://www.R-project.org).