Clinical Characteristics and Management of Non-Tuberculous Mycobacterial Skin and Soft Tissue Infections: A Retrospective Cohort Study

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Background: Non-tuberculous mycobacterial (NTM) skin and soft tissue infections (SSTI) present a significant treatment challenge, requiring prolonged, multidrug antibiotic regimens often associated with substantial toxicity and suboptimal clinical outcomes. We aim to describe the clinical characteristics and treatment of patients with NTM-SSTI in the Netherlands, focusing on host immune status and drug toxicity. Methods: We retrospectively collected data from adults with NTM-SSTI treated at 2 Dutch tertiary referral centers for mycobacterial disease between 2017 and 2024. Data included sociodemographics, medical history, antibiotic regimens, drug toxicity, and treatment outcomes. Results: (17/73; 23%). Azithromycin, the most prescribed drug, was discontinued prematurely because of toxicity in 35% (18/52) of patients, ethambutol in 33% (9/27), and clofazimine in only 12% (3/26). These discontinuations occurred mostly within the first 4 months. Immunocompromised patients with disseminated infections had longer (median 10.1 vs 7.6 vs 6.4 months) treatment durations and lower remission rates (29% vs 59% vs 86%) compared to immunocompromised patients with localized disease and immunocompetent patients, respectively. Conclusions: Immunocompromised status is associated with disseminated NTM-SSTI and worse treatment outcomes. Regardless of immune status, antimycobacterial drugs often cause toxicity, leading to treatment changes.

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