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Background <p>Nontuberculous mycobacteria (NTM) species diversity and NTM pulmonary infection and disease incidence vary geographically. Environmental factors influence geospatial variation; trace metals in untreated and treated water may increase the risk of NTM pulmonary infection.</p> Objective <p>To examine the effect of the trace metals chromium (Cr), cobalt (Co), molybdenum (Mo), strontium (Sr), vanadium (V), in public distribution system water on the presence of NTM in the showerhead biofilm in the United States (US).</p> Methods <p>We studied the presence of NTM in the showerhead biofilms as a function of trace metal exposure from public distribution system water in households across the US. We obtained data on trace metal concentrations from the US Environmental Protection Agency Third Unregulated Contaminant Monitoring Rule (UCMR 3) dataset. The EPA UCMR 3 water data collection occurred during 2013–2015; showerhead biofilm sample collection occurred during October 2016 – July 2017. We identified five NTM species in our dataset which comprise the majority of disease-associated species in the US: the <i>Mycobacterium avium</i> complex (MAC), <i>M. abscessus</i>, <i>M. fortuitum</i>, <i>M. mucogenicum, M. phocaicum</i>, to model as our response variable. NTM was defined as “present” in a sample if the relative abundance of these species were equal to or greater than 0.1% for a given showerhead observation. We used logistic regression models to estimate the odds of NTM presence in showerhead biofilm as a function of trace metal exposure in treated drinking water at the public water system (PWS) level. We assessed the influence of point-of-use (POU) water quality factors, as well as climate-related variables on our model. Our final models adjusted for POU nitrite concentrations and county-level precipitation levels.</p> Results <p>Our dataset included 446 showerhead biofilm samples across 47 states and 6,127 water samples measured for five trace metals in distribution system water across the US. We found that Mo and V were significantly associated with increased risk of NTM occurrence in showerhead biofilms in households across the US.</p> Conclusion <p>Higher concentrations of Mo and V are associated with increased likelihood of NTM occurrence in the showerhead, likely increasing the risk of exposure and infection.</p>

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NTM in showerhead biofilms associated with trace metals from public distribution system water in the United States

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月13日

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  • Ettie M. Lipner,
  • Collin Powell,
  • Matthew J. Gebert,
  • D. Rebecca Prevots

摘要

Background

Nontuberculous mycobacteria (NTM) species diversity and NTM pulmonary infection and disease incidence vary geographically. Environmental factors influence geospatial variation; trace metals in untreated and treated water may increase the risk of NTM pulmonary infection.

Objective

To examine the effect of the trace metals chromium (Cr), cobalt (Co), molybdenum (Mo), strontium (Sr), vanadium (V), in public distribution system water on the presence of NTM in the showerhead biofilm in the United States (US).

Methods

We studied the presence of NTM in the showerhead biofilms as a function of trace metal exposure from public distribution system water in households across the US. We obtained data on trace metal concentrations from the US Environmental Protection Agency Third Unregulated Contaminant Monitoring Rule (UCMR 3) dataset. The EPA UCMR 3 water data collection occurred during 2013–2015; showerhead biofilm sample collection occurred during October 2016 – July 2017. We identified five NTM species in our dataset which comprise the majority of disease-associated species in the US: the Mycobacterium avium complex (MAC), M. abscessus, M. fortuitum, M. mucogenicum, M. phocaicum, to model as our response variable. NTM was defined as “present” in a sample if the relative abundance of these species were equal to or greater than 0.1% for a given showerhead observation. We used logistic regression models to estimate the odds of NTM presence in showerhead biofilm as a function of trace metal exposure in treated drinking water at the public water system (PWS) level. We assessed the influence of point-of-use (POU) water quality factors, as well as climate-related variables on our model. Our final models adjusted for POU nitrite concentrations and county-level precipitation levels.

Results

Our dataset included 446 showerhead biofilm samples across 47 states and 6,127 water samples measured for five trace metals in distribution system water across the US. We found that Mo and V were significantly associated with increased risk of NTM occurrence in showerhead biofilms in households across the US.

Conclusion

Higher concentrations of Mo and V are associated with increased likelihood of NTM occurrence in the showerhead, likely increasing the risk of exposure and infection.