Adherence and Biofilm Formation of Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium abscessus in household plumbing

Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and found in drinking water distribution systems and household plumbing. They are opportunistic pathogens of humans, causing lung disease. Their ability to adhere and form biofilm is attributed to a waxy, lipid-rich, cell envelope. This highly hydrophobic envelope also contributes to the characteristic antibiotic-, chlorine-, and disinfectant- resistance of NTM.

NTM in household plumbing reside primarily in biofilms and the ability to form biofilm has been linked to virulence. Shedding of cells from biofilm and the subsequent aerosolization of microorganisms through showerheads presents a significant public health risk, particularly to those individuals with associated risk factors.

Three species of NTM, Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium abscessus, were examined for adherence and biofilm formation on surfaces common to household plumbing systems, including glass, copper, stainless steel, polyvinyl chloride, and galvanized steel. All experiments were conducted with sterile, Blacksburg tap water in a CDC Biofilm Reactor.

Highest adherence was observed by M. avium on galvanized steel surfaces, reaching 15,100 CFU/cm2 surface at 6 hours incubation at room temperature. After 3 weeks incubation at room temperature, biofilm formation of M. avium was also highest on galvanized steel surfaces, reaching 14,000,000 CFU/cm2 surface. Lowest adherence was observed by M. abscessus on polyvinyl chloride (PVC) surfaces, reaching 40 CFU/cm2. Lowest biofilm formation was observed by M. intracellulare on glass surfaces, reaching 5,900 CFU/cm2.

Surfaces, such as galvanized (zinc), on which high adherence and biofilm formation was observed, should be avoided in household plumbing systems of NTM patients and individuals at risk for developing NTM disease. Additionally, surfaces such as copper, harbor fewer NTM and may provide a safer alternative for household plumbing of NTM patients.