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US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis
  1. R Andres Floto1,2,
  2. Kenneth N Olivier3,
  3. Lisa Saiman4,
  4. Charles L Daley5,
  5. Jean-Louis Herrmann6,7,
  6. Jerry A Nick8,
  7. Peadar G Noone9,
  8. Diana Bilton10,
  9. Paul Corris11,
  10. Ronald L Gibson12,
  11. Sarah E Hempstead13,
  12. Karsten Koetz14,
  13. Kathryn A Sabadosa13,
  14. Isabelle Sermet-Gaudelus15,
  15. Alan R Smyth16,
  16. Jakko van Ingen17,
  17. Richard J Wallace18,
  18. Kevin L Winthrop19,
  19. Bruce C Marshall20,
  20. Charles S Haworth2
  1. 1Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
  2. 2Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
  3. 3Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
  4. 4Department of Pediatrics, Columbia University Medical Center, Pediatric Infectious Diseases, New York, New York, USA
  5. 5Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado, USA
  6. 6INSERM U1173, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France
  7. 7AP-HP, Service de Microbiologie, Hôpital Raymond Poincaré, Garches, France
  8. 8Department of Medicine, National Jewish Health, Denver, Colorado, USA
  9. 9The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  10. 10Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  11. 11Department of Respiratory Medicine, Freeman Hospital, High Heaton, Newcastle, UK
  12. 12Department of Pediatrics University of Washington School of Medicine, Seattle, Washington, USA
  13. 13The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  14. 14Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
  15. 15Service de Pneumo-Pédiatrie, Université René Descartes, Hôpital Necker-Enfants Malades, Paris, France
  16. 16Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
  17. 17Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
  18. 18Department of Microbiology, University of Texas Health Science Center, Tyler, Texas, USA
  19. 19Oregon Health and Sciences University, Portland, Oregon, USA
  20. 20Cystic Fibrosis Foundation, Bethesda, Maryland, USA
  1. Correspondence to Dr R Andres Floto, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0XY, UK; arf27{at}cam.ac.uk

Abstract

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with pre-existing inflammatory lung disease such as cystic fibrosis (CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered ‘good’ agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition.

  • Cystic Fibrosis
  • Bacterial Infection

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