Background
Managing nontuberculous mycobacterial (NTM) infections is challenging: resistance is a concern, effective drugs are scarce, treatment is long and potentially toxic. Because most clinicians? expertise handling NTM is limited, a national multidisciplinary clinical advisory board was established to support a harmonized approach in terms of diagnostic work-up and management, share knowledge and raise standards of care.

Methods
We report the first year experience of the NTM consilium. We collected data from the standardised case submission forms from Dec 2021 through Dec 2022.

Results
In 1 calendar year, we held 11 virtual meetings, attended by on average 12 physicians from 4 different specialties (pulmonology, microbiology, infectious diseases, and thoracic surgery). 53 cases  were presented, referred from 18 different centers in Flanders (n=42), Brussels (n=5), and Wallonia (n=4). The majority were pulmonary cases (70%). The most frequent extrapulmonary presentations were disseminated disease (n=8) and osteomyelitis (n=8). M. avium complex was the most common species, followed by M. abscessus complex. The majority of questions related to treatment advice (35.8%), therapy adjustments (28.3%), indication to treat and timing of start (26.4%), or a combination of the latter two (9.4%). 

Conclusion
The NTM consilium addresses an unmet need in NTM clinical care in Belgium: gathering multidisciplinary expertise and providing advice on treatment initiation, constitution or adjustments. It could support the cause for a prospective national NTM registry linking microbiology and clinical outcome as well as basis for future research in NTM.