Reducing Exposure to Nontuberculous Mycobacteria

NTM are bacteria with a lipid-rich, impermeable outer membrane that results in slow growth, antibiotic-resistance, disinfectant-resistance (e.g., chlorine), acid-tolerance, and propensity to stick to pipe surfaces. The lipid-rich outer membrane is the major determinant of their ecology as: (1) NTM grow slowly because they use a great deal of energy to make the long chain fatty acids in the outer membrane, (2) NTM are impermeable to nutrients, but impermeability makes them resistant to disinfectants and antibiotics, (3) NTM are hydrophobic so they are very poor at taking up nutrients, but hydrophobicity drives surface attachment and growth (biofilm formation), where they will not be washed away in pipes, and (4) NTM hydrophobicity means they are more readily aerosolized than other bacteria (1).