Distribution, prevalence of non-tuberculous mycobacteria on Hainan Island and antibiotic resistance of <i>Mycobacterium abscessus</i>

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.