Myco-NET

Non-tuberculous mycobacterial (NTM) infections pose a growing public health challenge. Their incidence is steadily increasing, while there remains a significant need for diagnosis, management, and the development of new therapeutic strategies. In light of these challenges, strengthening clinical research appears essential.

The network brings together French hospitals involved in the care and research of NCDs. By bringing clinicians and microbiologists together, it facilitates the development and conduct of multicenter studies while improving the identification and enrollment of patients in clinical trials.

The Myco-NET network is coordinated by Prof. Claire Andrejak and co-coordinated by Prof. Nicolas Veziris . Its governance is based on a coordination committee, a steering committee, and a scientific committee.

The network's activities are organized around 6 working groups (WG), each dedicated to a specific topic:

• WG1 – Governance: organization and coordination of the network.
• WG2A – Epidemiology and Diagnosis: improving knowledge of NTD infections through epidemiological studies and the development of collaborations with clinicians on NTD infections (diagnosis, alerts, monitoring, antimicrobial testing, etc.).
• WG2B – Interventional Studies: evaluation of interventions for the management of patients with MNT infections or those at risk for pulmonary MNT infection.
• WG3 – Development of new antibiotics (or new antibiotic combinations): development of antibiotics, from design through preclinical studies. 
• WG4 – Innovative biomarkers: study of vulnerability to MNT infections and improvement of diagnostic and prognostic tools for patient care.
• WG5 – “One Health” prevention: identification of sources of NCD infections to promote prevention strategies.
• WG6 – Participatory Medicine / Communication: facilitating patient participation in managing their disease and ensuring communication between network members and the target audience. 

A national research ecosystem

Myco-NET is supported by 46 hospitals (including 30 CICs) located throughout France, 9 research units, the National Reference Center for Mycobacteria (CNR-MyRMA), academic partners (INRAE, Eaux de Paris, Inserm), industry partners (Genoscreen, Insmed, Bioversys, Qiagen), and two patient associations (“Mon Air, Mon Poumon” and “Vaincre la Mucoviscidose”).

At each center, a clinician-microbiologist team is designated to facilitate patient identification and enrollment. Patient identification relies in particular on national multidisciplinary consultation meetings (RCPs) dedicated to NCDs, which allow for the discussion of complex cases and the referral of patients to available studies.

Finally, the network is developing national cohorts, as well as projects focusing on biomarkers, new therapeutic approaches, and the vulnerability and environmental factors involved in NTD infections.

The network operates in various fields of expertise and offers a range of services to investigators and sponsors.

Each year, the network contributes to concrete advances in clinical research, with several studies completed. Here are a few examples:

• CaMoMy Trial: a clinical trial evaluating the rate of negative cultures at 6 months of properly administered treatment for pulmonary infection caused by M. xenopi (rifampin-ethambutol with clarithromycin or moxifloxacin). The results allow for the proposal of two treatment regimens for pulmonary infections caused by M. xenopi and finally provide a reference value for calculating the required sample size in future studies in this field.
• RCPMyco Study: a cohort study on requests for multidisciplinary consultation (MDC) regarding nontuberculous mycobacteria, to assess the primary reason for submitting a case to a multidisciplinary consultation meeting in the context of nontuberculous mycobacterial infections. The objective was to identify needs, whether in terms of training for physicians managing this type of infection or in terms of clinical research to be conducted (to better understand the main challenges in managing these infections). The study highlighted the need for training and/or French reference materials to assist in diagnosing the infection. 
• Thanks to the MYCOMED network, which served as a precursor to the MYCO-NET network, two studies have described the characteristics and management in France of two types of MNT infections: pulmonary mycobacteriosis and lymphadenitis in children. The data have been published.
• ENCORE Trial: an international randomized controlled trial comparing nebulized liposomal amikacin versus placebo in combination with azithromycin and ethambutol in patients with M. avium complex (conducted by Insmed Biotech, with participation from several Myco-NET centers). Patients with cavitary lesions larger than 2 cm were excluded. The study has been completed. The results were presented at the American Thoracic Society conference in May 2026.

The network is currently involved in several multicenter studies aimed at advancing knowledge and clinical practice, including:

• CLAZI Trial: a randomized controlled trial comparing two treatment arms for pulmonary infection with M. avium complex (clarithromycin versus azithromycin, in combination with rifampin and ethambutol). Clarithromycin-based therapy is the standard of care, but azithromycin appears to be better tolerated with fewer side effects. This is a non-inferiority study. Patient enrollment is currently underway.
• AKAPI Trial: a randomized controlled trial comparing two treatment arms for pulmonary infection caused by M. xenopi (clarithromycin, rifampin, and ethambutol, with or without nebulized liposomal amikacin). This is a superiority study evaluating whether nebulized liposomal amikacin shortens the time to negative cultures and, consequently, the duration of treatment. 

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