Antimicrobial Therapy, Disinfection, Resistance Mechanisms, and Microbiota Interactions in Nontuberculous Mycobacteria: Current Evidence and Emerging Perspectives.
- 1Department of Biochemistry, Pasteur Institute of Iran, Tehran, Iran.
- 2Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran.
- 3Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran.
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.
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BibTeX
@article{jajin2026antimicrobial,
title = {{Antimicrobial Therapy, Disinfection, Resistance Mechanisms, and Microbiota Interactions in Nontuberculous Mycobacteria: Current Evidence and Emerging Perspectives.}},
author = {Morteza Ghazanfari Jajin and Abolfazl Fateh},
journal = {Infection and drug resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s642597},
url = {https://europepmc.org/article/MED/42974473},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Antimicrobial Therapy, Disinfection, Resistance Mechanisms, and Microbiota Interactions in Nontuberculous Mycobacteria: Current Evidence and Emerging Perspectives.
AU - Morteza Ghazanfari Jajin
AU - Abolfazl Fateh
PY - 2026
DA - 2026/10/29
JO - Infection and drug resistance
DO - 10.2147/idr.s642597
UR - https://europepmc.org/article/MED/42974473
AB - 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.
SN - 1178-6973
ER -