Clinical Presentation, Risk Factors and Outcome of Non-Tuberculous Mycobacteria Infection in Hematopoietic Stem-Cell Transplantation: A Multinational Case-Control Study

Mario Fernández-Ruiz; Jose Tiago Silva; Peggy L Carver; Sasinuch Rutjanawech; Luis F Aranha-Camargo; Ruan Fernandes; Sara Belga; Amenah Alghamdi; Nicolas J Mueller; Sara Burkhard; Nicole M Theodoropoulos; Douwe F Postma; Pleun J van Duijn; Francisco Arnaiz de Las Revillas; Concepción Pérez Del Molino-Bernal; Jonathan Hand; Adam Lowe; Marta Bodro; Elisa Vanino; Ana Fernández-Cruz; Antonio Ramos-Martínez; Mateja Jankovic Makek; Ribal Bou Mjahed; Oriol Manuel; Antonia Calvo-Cano; Laura Rueda-Carrasco; Ana Álvarez-Uría; Regino Rodríguez-Álvarez; Alessandra Mularoni; Elisa Vidal; Teresa Del Rosal; Yasmina Mozo; Annika Y Classen; Carlos Mejía-Chew; Francisco López-Medrano

doi:10.1093/ofid/ofag082

Clinical Presentation, Risk Factors and Outcome of Non-Tuberculous Mycobacteria Infection in Hematopoietic Stem-Cell Transplantation: A Multinational Case-Control Study

Open Forum Infect Dis. 2026 Feb 19;13(2):ofag082. doi: 10.1093/ofid/ofag082. eCollection 2026 Feb.

Authors

Mario Fernández-Ruiz^{1

2}, Jose Tiago Silva^{1

2}, Peggy L Carver³, Sasinuch Rutjanawech⁴, Luis F Aranha-Camargo⁵, Ruan Fernandes⁵, Sara Belga⁶, Amenah Alghamdi⁷, Nicolas J Mueller⁸, Sara Burkhard⁸, Nicole M Theodoropoulos⁹, Douwe F Postma¹⁰, Pleun J van Duijn¹¹, Francisco Arnaiz de Las Revillas^{2

12}, Concepción Pérez Del Molino-Bernal^{2

12}, Jonathan Hand¹³, Adam Lowe¹³, Marta Bodro^{2

14}, Elisa Vanino¹⁵, Ana Fernández-Cruz¹⁶, Antonio Ramos-Martínez¹⁶, Mateja Jankovic Makek¹⁷, Ribal Bou Mjahed¹⁸, Oriol Manuel¹⁸, Antonia Calvo-Cano¹⁹, Laura Rueda-Carrasco¹⁹, Ana Álvarez-Uría²⁰, Regino Rodríguez-Álvarez²¹, Alessandra Mularoni²², Elisa Vidal^{2

23}, Teresa Del Rosal²⁴, Yasmina Mozo²⁴, Annika Y Classen^{25

26}, Carlos Mejía-Chew⁴, Francisco López-Medrano^{1

2}

Affiliations

¹ Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.
² Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
³ Department of Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.
⁴ Department of Infectious Diseases, Washington University School of Medicine, St.Louis, Missouri, USA.
⁵ Department of Infectious Diseases, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁶ Division of Infectious Diseases, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
⁷ Division of Infectious Diseases, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
⁸ Department of Infectious Diseases, University Hospital Zurich, Zurich, Switzerland.
⁹ Department of Infectious Diseases, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹⁰ Department of Internal Medicine and Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹¹ Department of Clinical Microbiology, Certe Laboratory for Infectious Diseases,Groningen, The Netherlands.
¹² Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
¹³ Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA.
¹⁴ Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain.
¹⁵ Unit of Infectious Diseases, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy.
¹⁶ Department of Internal Medicine, Unit of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Spain.
¹⁷ Department for Pulmonary Diseases, School of Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia.
¹⁸ Department of Infectious Diseases, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
¹⁹ Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University Institute of Biosanitary Research of Extremadura (INUBE), Area of Medicine, University of Extremadura, Badajoz, Spain.
²⁰ Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Biomedical Research Institute Gregorio Marañon (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Universidad Complutense, Madrid, Spain.
²¹ Department of Infectious Diseases, Hospital Universitari de Cruces, Barakaldo, Spain.
²² Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCC-ISMETT), Palermo, Italy.
²³ Department of Infectious Diseases, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
²⁴ Department of General Pediatrics and Infectious Diseases, Hospital Universitario La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), Universidad Autónoma de Madrid, Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.
²⁵ Department I for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
²⁶ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.

Abstract

Background: The clinical and microbiological features of infection due to non-tuberculous mycobacteria (NTM) after hematopoietic stem-cell transplantation (HSCT) remain poorly understood.

Methods: We performed a retrospective, multinational case-control study that included HSCT recipients (≥12 years) diagnosed with NTM disease between January 2008 and December 2018. Controls were HSCT recipients with no evidence of NTM disease, matched (1:2 ratio) by participating center and post-transplant survival. Logistic regression on matched pairs was used to investigate risk factors for NTM disease.

Results: We included 25 cases of NTM disease. The most common HSCT type was allogeneic from unrelated donor (72.0%) after myeloablative conditioning (76.0%). Predominant hematological conditions were acute myelogenous leukemia (28.0%) and myelodysplastic syndrome (24.0%). Most patients (88.0%) had previously received immunosuppressive therapy. The most common species identified were Mycobacterium avium complex (64.0%) and rapidly growing mycobacteria (20.0%). Most patients (68.0%) had pulmonary disease. All but one received antimycobacterial therapy for a median of 267.5 days. Macrolides (83.3%), rifamycins (58.3%) and ethambutol (62.5%) were the most commonly used drugs. Four patients (16.7%) developed adverse events requiring therapy discontinuation. All-cause and attributable mortality rates were 28.0% and 4.0%, respectively. One patient experienced relapse after 464 days. Diagnosis of a non-NTM infection (adjusted odds ratio [aOR]: 3.11; 95% confidence interval [95% CI]: 1.25-7.78) and corticosteroid therapy (aOR: 2.88; 95% CI: 1.16-7.17), both within the previous 90 days, were associated with NTM disease.

Conclusions: NTM disease is a serious complication among heavily immunocompromised HSCT recipients associated with prior non-NTM infection and corticosteroid therapy.

Keywords: case-control study; hematopoietic stem-cell transplantation; non-tuberculous mycobacteria; risk factors; treatment.