dNontuberculous mycobacteria (NTM) are an important cause of pulmonary disease in patients with cystic fibrosis (CF). A new culture medium (RGM medium) for the isolation of rapidly growing mycobacteria from the sputum of cystic fibrosis patients has recently been reported. The aim of this study was to compare culture of sputum samples on RGM medium with culture using a standard automated liquid culture method. Sputum samples were obtained from 187 distinct patients with CF attending King's College Hospital, London, United Kingdom. Each sample was decontaminated with 3% oxalic acid and inoculated into a mycobacterial growth indicator tube (MGIT) that was monitored for 42 days using the Bactec MGIT 960 instrument. Each sample was also cultured, without decontamination, onto RGM medium, which was incubated for 10 days at 30°C. Mycobacteria were isolated from 28 patients (prevalence, 15%). Mycobacteria were detected in 24 samples (86%) using the MGIT and in 23 samples (82%) using RGM medium (P ‫؍‬ 1.00). In this setting, RGM medium showed sensitivity equivalent to that of the MGIT for isolation of NTM from the sputum of patients with CF. RGM medium offers a simple, convenient tool that can be embedded into routine culture methods, allowing the culture of all sputum samples that are submitted from patients with CF. N ontuberculous mycobacteria (NTM) are an important cause of pulmonary disease in patients with cystic fibrosis (CF) (1). In the largest studies, the prevalence of NTM in sputum has been estimated to be 6 to 13% for patients with CF (2), and there is convincing evidence that prevalence is increasing in the CF population (3-6). NTM are detected by culture of sputum using methods that were designed primarily for the isolation of Mycobacterium tuberculosis. Consensus guidelines state that culture should be performed in liquid media using an automated growth detection system (such as the mycobacterial growth indicator tube [MGIT]) and note that concomitant culture on solid media (e.g., Lowenstein-Jensen medium) may increase the diagnostic yield (1).Detection of NTM is frequently challenging due to the presence of other bacterial and fungal species in the lungs of CF patients. Competing species typically show a higher growth rate than mycobacteria and are frequently resistant to multiple antibiotics that might be used to select for growth of mycobacteria. To resolve this, sputum samples are subjected to treatment with chemicals in order to eliminate or reduce the burden of nonmycobacterial species. Chemical treatments include N-acetyl-L-cysteine (0.5%) plus sodium hydroxide (2%), 5% oxalic acid, or 1% chlorhexidine (1). However, such decontamination protocols are labor intensive, they may reduce the viability of NTM, and they may be ultimately unsuccessful if there is a high burden of nonmycobacterial species (7-9).Culture on solid agar-based media is an attractive option as this can potentially allow recovery of NTM even in specimens that contain other viable species. For example, Esther et al. (10) demonstrat...

The new strategic health authorities should make it a priority to assess inequity in the provision of services within their areas, investigate the possible causes and support the primary care trusts to implement plans to address them.

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