Nosocomial and Healthcare-Associated NTM Infections and Their Control

Nontuberculous mycobacteria (NTMs) are ubiquitous environmental organisms which makes them ideal nosocomial pathogens. Their resistance to extreme environments and disinfectants further increase their potential for causing healthcare-associated (HCA) and iatrogenic infections. Furthermore, the increasing proportion of immunosuppressed patients in healthcare environments on prophylactic antibiotics and antivirals makes infection with NTMs likely as they are usually resistant to prophylactic agents used. Despite these growing concerns of HCA NTM infections, no international consensus or guidelines exist on specific disinfection and prevention practices. Most infections are only recognized as part of larger outbreaks and only investigated for a healthcare link when an outbreak is suspected. Sporadic iatrogenic infections are missed due to lack of awareness of NTM pathology, clinical signs and symptoms, and inability to recover NTMs in culture. Moreover, outbreak investigations also suffer from a lack of understanding of the environmental reservoirs, transmission routes, and putative control measures.This chapter explores the relationship of NTM infections with the nosocomial and healthcare environment, predisposing risk factors, and possible preventive measures to control NTM infections in these environments.