Open Access Highly Accessed Research article

Burden and trends of hospitalisations associated with pulmonary non-tuberculous mycobacterial infections in Germany, 2005–2011

Felix C Ringshausen1*, Rosa-Marie Apel1, Franz-Christoph Bange2, Andrés de Roux3, Mathias W Pletz4, Jessica Rademacher1, Hendrik Suhling1, Dirk Wagner5 and Tobias Welte1

Author Affiliations

1 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany

2 Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany

3 Centre for Respiratory Medicine at the Charlottenburg Castle, Berlin, Germany

4 Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany

5 Centre for Infectious Diseases and Travel Medicine and Centre for Chronic Immunodeficiency, University Hospital Freiburg, Freiburg, Germany

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BMC Infectious Diseases 2013, 13:231  doi:10.1186/1471-2334-13-231

Published: 21 May 2013



Representative population-based data on the epidemiology of pulmonary non-tuberculous mycobacterial (PNTM) infections in Europe are limited. However, these data are needed in order to optimise patient care and to facilitate the allocation of healthcare resources. The aim of the present study was to investigate the current burden and the trends of PNTM infection-associated hospitalisations in Germany.


International Classification of Diseases, 10th revision (ICD-10) discharge diagnosis codes were extracted from the official nationwide diagnosis-related groups (DRG) hospital statistics in order to identify PNTM infection-associated hospitalisations (ICD-10 code A31.0) between 2005 and 2011. Poisson log-linear regression analysis was used to assess the significance of trends.


Overall, 5,959 records with PNTM infection as any hospital discharge diagnosis were extracted from more than 125 million hospitalisations. The average annual age-adjusted rate was 0.91 hospitalisations per 100,000 population. Hospitalisation rates increased during the study period for both males and females, with the highest rate of 3.0 hospitalisations per 100,000 population among elderly men, but the most pronounced average increase of 6.4%/year among females, particularly those of young and middle age, and hospitalisations associated with cystic fibrosis. Overall, chronic obstructive pulmonary disease (COPD) was the most frequent PNTM infection-associated condition in 28.9% of hospitalisations and also showed a significant average annual increase of 4.8%.


The prevalence of PNTM infection-associated hospitalisations is steadily increasing in Germany. COPD is currently the most important associated condition. Our population-based study provides evidence of a changing epidemiology of PNTM infections and highlights emerging clinical implications.

Atypical mycobacterial infection; Bronchiectasis; Clinical epidemiology; COPD epidemiology; Cystic fibrosis; Health services research; International classification of diseases; Mycobacterium avium complex; Non-tuberculous mycobacteria; Tuberculosis