Yield of testing for nontuberculous mycobacteria in patients with obstructive lung diseases and/or lung malignancy in Croatia

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Introduction: obstructive lung diseases (OLD) - chronic obstructive pulmonary disease (COPD) and asthma, and lung malignancy are common comorbidities in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD), and screening for NTM in these patients is often advocated. However, there is little data on the yield of unstructured testing in these patient groups. Aims and objectives: to assess the NTM isolation prevalence and the prevalence of NTM-PD in patients with OLD and/or lung malignancy. Methods: retrospective analysis of all mycobacterial cultures taken from respiratory samples of patients with OLD (either during exacerbation or during stable disease) and/or lung malignancy referred to our center from January 2021 to January 2023. Latest criteria from the four societies were used to assess for NTM-PD. Results: NTM isolation prevalence amounted to 0.48% (4/834) in patients with lung malignancies, 2.4% (13/553) in stable OLD, and 3.5% (8/228) in OLD in exacerbation, respectively. NTM-PD criteria were met in 32% (8/25) of NTM isolation episodes, all in the OLD cohort. In the OLD cohort, the likelihood of NTM isolation was higher in patients with lower BMI (p=0.004), frequent exacerbators (p=0.004), and patients on inhaled corticosteroid (ICS) therapy (p=0.012). NTM-PD was also more likely in patients with lower BMI (p=0.042), and frequent exacerbators (p=0.023), but not in patients on ICS therapy (p=0.48), regardless of the dose. Conclusions: in our setting, the yield of NTM testing patients with OLD and/or lung malignancy is generally low. However, testing for NTM might be feasible in OLD patients with low BMI and/or frequent exacerbators.

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