Introduction: Non-tuberculous mycobacteria (NTM) are increasingly recognized as clinically relevant pathogens, especially in immunocompromised children. However, population-based data on pediatric NTM hospitalizations in the U.S. are scarce. The objectives of this study were to describe the national epidemiology and analyze prevalence and trends of NTMs among hospitalized children in the U.S.
Methods: A retrospective serial cross-sectional study using the 2000, 2003, 2006, 2009, 2012, 2016, 2019, and 2022 Kids’ Inpatient Databases was conducted. NTM infections were identified using ICD-9 and ICD-10 codes. Demographics and clinical outcomes were compared with non-NTM discharges using chi-square and Mann-Whitney U tests and regression analysis. The Extended Mantel-Haenszel test was used for linear trend analysis.
Results: Out of 26.1 million discharges, NTM infections were present in 5,508 (0.02%). The prevalence of NTM hospitalizations increased from 0.12% in 2000 to 0.26% in 2022 (p < 0.001). NTM infections were more common in older, White children (48.3% vs 42.6%; p< 0.001) with private insurance (43.6% vs 41.3%; p< 0.001), in urban locations (83.8% vs 77.0%; p< 0.001), and in the Southern (aOR 1.23, CI 1.12-1.35) and Western U.S. (aOR 1.28, CI 1.16-1.41; Ref: Northeast). Pulmonary NTM was the most frequent type (36.8%). Children with NTM infections were more likely to have comorbid conditions, most notably localized lymphadenopathy (aOR 152, CI 141-164), HIV infections (10.2% vs 0.047%; aOR 147, CI 123-177), cystic fibrosis (40% vs 0.5%; aOR 89, CI 82-96), and other complex chronic conditions (CCC). They were more likely to require invasive mechanical ventilation (4.3% vs 2.3%; OR 1.9, CI 1.7-2.2) and have longer hospital stays (15.2 vs 4.5 days), greater hospital charges ($280,565 vs $58,607), and higher mortality (1.9% vs 0.3%; OR 5.5, CI 4.5-6.7) (all p< 0.001).
Conclusions: Although uncommon, NTM infections among hospitalized children in the U.S. are increasing. Demographic and regional variation is seen with NTM prevalence. Children who have HIV, cystic fibrosis, or other CCCs are at increased risk. Strengthening awareness, enhancing surveillance, and advancing targeted research are critical to improving prevention and management strategies.
