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This study analyzes 158 clinical respiratory samples from 2015 to 2018 across 14 cities, identifying 118 NTM isolates from 24 species. Predominant species include\n                      <jats:italic toggle=\"yes\">Mycobacterium abscessus<\/jats:italic>\n                      (23.73%),\n                      <jats:italic toggle=\"yes\">M. intracellulare<\/jats:italic>\n                      (22.03%), and\n                      <jats:italic toggle=\"yes\">M. simiae<\/jats:italic>\n                      (14.41%). Spatial mapping reveals elevated prevalence in coastal areas, with no significant north-south divergence on the island (Bray-Curtis dissimilarity: 0.5954,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.694), but substantial differences from mainland China (North: 0.9604,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0011; South: 0.9340,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0013). Antimicrobial testing of\n                      <jats:italic toggle=\"yes\">M. abscessus<\/jats:italic>\n                      isolates indicates complete resistance to doxycycline (100%), moderate sensitivity to amikacin (71.4%) and linezolid (50.0%), and variable responses to other agents. Novel detections of\n                      <jats:italic toggle=\"yes\">M. algericus<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">M. sinensis<\/jats:italic>\n                      expand Hainan\u2019s NTM diversity. These findings establish a baseline for region-specific surveillance, antibiotic stewardship, and intervention strategies to combat NTM misdiagnosis and mortality in tropical settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>Previous studies have not covered the distribution of non-tuberculous mycobacteria (NTM) in various regions of Hainan Province. This study provides the first comprehensive geographic map of NTM in Hainan, China's tropical island hotspot. By monitoring NTM across 14 cities over 4 years, we reveal key patterns in their habitat preferences and dominant species in infections. These findings establish a foundational framework for region-specific surveillance and treatment protocols in Hainan and offer a replicable model for global tropical regions combating NTM infections. Ultimately, this work empowers public health initiatives to reduce misdiagnosis, enhance antibiotic stewardship, and lower mortality rates among at-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01134-25","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T14:03:54Z","timestamp":1764338634000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Distribution, prevalence of non-tuberculous mycobacteria on Hainan Island and antibiotic resistance of\n                    <i>Mycobacterium abscessus<\/i>"],"prefix":"10.1128","volume":"14","author":[{"given":"Xinru","family":"Xu","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/004eeze55","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Immunology,, Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Key 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