Work

Antimicrobial Therapy, Disinfection, Resistance Mechanisms, and Microbiota Interactions in Nontuberculous Mycobacteria: Current Evidence and Emerging Perspectives

Year: 2026

Type: review

Abstract: : Nontuberculous mycobacteria (NTM) are emerging as prominent opportunistic pathogens that cause a global increase in pulmonary and extrapulmonary infections, although isolation of NTM from a clinical specimen does not by itself indicate clinically significant disease. The intrinsic resistance of many NTM species to standard antibiotics and disinfectants, attributed to a lipid-rich cell wall, robust efflux pumps, enzymatic drug inactivation, and biofilm formation, complicates both clinical management and environmental control, and resistance patterns differ substantially between species and subspecies. This narrative review, based on a structured literature search, summarizes guideline-supported antibiotic therapies for major NTM species, including the Mycobacterium avium complex (MAC) and M. abscessus , and discusses emerging and investigational approaches, such as bedaquiline, omadacycline, tedizolid, novel beta-lactam/beta-lactamase inhibitor combinations, and bacteriophage therapy, distinguishing in vitro, animal, and clinical evidence. Additionally, we examined the efficacy and limitations of high-level disinfectants including glutaraldehyde, peracetic acid, orthophthalaldehyde, and hydrogen peroxide, based mainly on laboratory studies and outbreak reports. Notably, documented failures in healthcare water systems and medical equipment are consistent with the resilience of NTM biofilms. The host microbiota, including both the pulmonary and intestinal microbiota, is another area of interest. Studies have linked microbiome composition to underlying lung disease, antimicrobial exposure, and NTM susceptibility, colonization, and treatment-related changes. However, evidence directly linking the microbiota to NTM antimicrobial resistance remains limited. Experimental findings suggest that antibiotic-induced changes in the lung microbiome may weaken colonization resistance, while alterations in the gut microbiota may influence immune responses through the gut–lung axis. The extent to which these effects contribute to NTM resistance or affect clinical outcomes remains unclear. This review considers microbiota interactions alongside antimicrobial therapy, disinfection, environmental persistence, and antibiotic selection pressure, distinguishing established practices from approaches that require further investigation. Microbiota-directed strategies therefore remain experimental. Keywords: nontuberculous mycobacteria, antibiotic resistance, disinfectants, microbiota, dysbiosis

Source: Infection and Drug Resistance

DOI: 10.2147/idr.s642597

Authors: Morteza Ghazanfari Jajin, Abolfazl Fateh

Institution: Pasteur Institute of Iran

Language: English

Topic: Mycobacterium research and diagnosis

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836