Table 8 CFF / ECFS recommendations for microbiological procedures for diagnosis of NTM lung disease in patients with cystic fibrosis (CF) [1]

•Cultures for NTM should be performed annually in spontaneously expectorating individuals with a stable clinical course.

•In the absence of clinical features suggestive of NTM pulmonary disease, individuals who are not capable of spontaneously producing sputum do not require screening cultures for NTM.

•Culture and smears for acid-fast bacilli from sputum should be used for NTM screening.

•Oro-pharyngeal swabs should not be used for NTM screening.

•Cultures and smears for acid-fast bacilli from sputum, induced sputum, bronchial washings or broncho-alveolar lavage samples can be used to evaluate individuals with CF suspected to have NTM-pulmonary disease.

•Respiratory tract samples should be cultured using both solid and liquid media and incubated for a minimum of six weeks.

•Respiratory tract samples should be decontaminated using N-acetyl L-cysteine NALC (0.5%) - NaOH (2%).

•If a sample remains contaminated with Gram-negative bacteria after standard decontamination, it should be further treated with either 5% oxalic acid or 1% chlorhexidine.

•Non-culture based methods should not be used to detect NTM in respiratory tract samples.