COVID-19疫情前後非結核分枝桿菌（NTM）感染的發生率與相關風險分析

Incidence and Associated Risks of Nontuberculous Mycobacterial Infections Before and After the COVID-19 Pandemic

背景：非結核分枝桿菌（nontuberculous mycobacteria，NTM）為日益受到重視的環境性機會致病菌，主要影響高齡者、慢性肺部疾病患者及免疫功能低下族群。COVID-19疫情改變了醫療資源配置、就醫行為與宿主免疫風險結構，可能進一步影響NTM感染的流行病學特徵。
目的：本研究旨在評估COVID-19疫情前後NTM感染的時間趨勢與相關風險，並比較COVID-19確診患者與未確診對照族群於後續一年內發生NTM感染及其他不良臨床結局的風險差異。
方法：本研究使用TriNetX Analytics聯邦式電子病歷資料平台，分析美國68家醫療機構之去識別化就醫資料。研究分為兩部分：（1）分析2018年至2024年NTM與COVID-19每季就診率變化；（2）建立COVID-19陽性與非COVID-19對照世代，經1：1傾向分數配對後，評估一年內NTM感染及其他臨床預後之風險。配對後每組各納入1，967，262名患者。
結果：2020年後，NTM就診率呈上升趨勢，尤以高齡族群較為明顯。配對後分析顯示，COVID-19感染者於一年內發生NTM感染的風險顯著高於非COVID-19對照組（hazard ratio [HR]，1.339；95% confidence interval [CI]，1.176–1.524；p<0.001）。此外，COVID-19組亦呈現較高的全因死亡（HR，2.920）、加護病房收治（HR，2.524）、肺部併發症（HR，4.672）及敗血症連鎖反應（HR，2.891）風險。
結論：本研究顯示，COVID-19疫情後NTM感染的就診率與風險結構可能出現改變。COVID-19感染後患者於一年內發生NTM感染及多項不良臨床結局的風險升高，提示此族群需要更積極的長期監測與風險分層照護策略。

Background: Nontuberculous mycobacteria (NTM) are opportunistic environmental pathogens of increasing clinical importance, particularly in older adults, patients with chronic lung disease, and immunocompromised populations. The COVID-19 pandemic may have altered healthcare utilization, host immune risk profiles, and the epidemiology of opportunistic infections.
Objective: This study evaluated the temporal trends in NTM infections before and after the COVID-19 pandemic and compared the 1-year risk of NTM infection and adverse clinical outcomes between patients with and without COVID-19.
Methods: We used the TriNetX Analytics federated electronic health record platform to analyze de-identified data from 68 healthcare organizations in the United States. The study included two components: (1) quarterly NTM and COVID-19 visit-rate analyses from 2018 to 2024; and (2) a retrospective cohort comparison of COVID-19-positive patients and non-COVID-19 controls. After 1:1 propensity score matching, each group included 1,967,262 patients. NTM infection was defined using the ICD-10-CM code A31 and represented all-site or unspecified-site NTM diagnoses rather than pulmonary-only disease.
Results: After 2020, quarterly NTM visit rates increased, particularly among older adults. In the matched cohort analysis, COVID-19 was associated with a significantly higher 1-year risk of NTM infection compared with the non-COVID-19 control group (hazard ratio [HR], 1.339; 95% confidence interval [CI], 1.176–1.524; p < 0.001). COVID-19 was also associated with higher risks of all-cause mortality (HR, 2.920), intensive care unit admission (HR, 2.524), pulmonary complications (HR, 4.672), and sepsis cascade events (HR, 2.891).
Conclusion: NTM visit rates and risk profiles may have changed after the COVID-19 pandemic. Patients with COVID-19 had an increased 1-year risk of NTM infection and multiple adverse clinical outcomes, suggesting the need for long-term monitoring and risk-stratified care in this population.