Nontuberculous Mycobacterial Infections in Continuous Ambulatory Peritoneal Dialysis Patients

White, Ralph de Vere; Abreo, Kenneth; Flanagan, R.J.; Gadallah, Merit F.; Krane, Kevin; EI-Shahawy, Mohamed; Shakamuri, Shoba; McCoy, Regina

doi:10.1016/s0272-6386(12)80932-2

Cited by 55 publications

(41 citation statements)

References 16 publications

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“…The clinical presentation, initial laboratory studies, and PD fluid characteristics are similar to other reported cases in the literature of nontuberculous mycobacterium peritonitis, specifically for Mycobacterium fortuitum [2][3][4][5][6][7][8][9][10]. Although a negative Gram stain of the PD fluid is characteristic, an initial positive Gram stain for bacteria may also be seen at presentation [7].…”

Section: Discussionsupporting

confidence: 66%

<i>Mycobacterium fortuitum </i>Peritonitis in Two Patients Receiving Continuous Ambulatory Peritoneal Dialysis

Vera

Lew²

1999

Am J Nephrol

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We present two cases of non-resolving peritonitis treated with a standard peritonitis protocol. The organism identified from the peritoneal effluent was Mycobacterium fortuitum, a group IV (Runyon’s classification) rapidly growing, nontuberculous mycobacterium. M. fortuitum is ubiquitous and can be isolated from a number of natural sources. Risk factors these two patients had for developing M. fortuitum peritonitis included underdialysis, the immunocompromised state associated with end stage renal disease, prior or prolonged broad spectrum antibiotic treatment, and possible exposure to environmental factors, since both were hospitalized at about the same time. The isolates were resistant to the conventional antibiotics recommended for the treatment of this mycobacterium. Both patients, however, responded to catheter removal and antibiotics administered according to the sensitivities of the mycobacterium isolated.

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Section: Discussionsupporting

confidence: 66%

<i>Mycobacterium fortuitum </i>Peritonitis in Two Patients Receiving Continuous Ambulatory Peritoneal Dialysis

Vera

Lew²

1999

Am J Nephrol

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“…It is extremely rare to find PD catheter-related NTB mycobacterial infections. Previous articles dealing with PD catheter-related infection were reviewed, and their main features are shown in Table 2 [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Summarizing the previous reports, adults (17 men, 12 women) had an average age of 47.7 ± 18.1 years at the time of diagnosis with PD catheter-related infection.…”

Section: Discussionmentioning

confidence: 99%

A hospital-acquired outbreak of catheter-related nontuberculous mycobacterial infection in children on peritoneal dialysis

Yamada¹,

Ushijima²,

Uemura³

2014

CEN Case Rep

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Catheter-related nontuberculous mycobacterial infection in children with chronic renal failure on peritoneal dialysis (PD) is rare. However, there have been five such infections in infants among PD patients at our center. Although the patients were treated with antibiotics to which the organisms showed in vitro sensitivity, they were clinically drug resistant. Hence, all PD catheters needed to be removed. Thereafter, following hemodialysis treatment for approximately 1 month, the PD catheters were replaced, with no recurrence of infection. On investigation of the infection route, it was found that these bacteria had colonized around a shower head in one of the bathrooms. These findings suggest that, in cases where hot water systems at hospitals are considered at a high risk, frequent sterilization is needed, especially around the shower heads. It is also necessary to reconsider current standard practices in the management of catheter exit sites, especially if the national incidence of infection increases.

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“…In general practice, M. avium comprises 80% of total NTM infections, and most of other NTM infections are caused by M. kansasii. However, the cases reported with PD have mainly been induced by rapidly growing NTMs, M. fortuitum 5,14) , M. chelonae 4,11,13) and M. abscessus 13,15) , rather than slow-growing species, M. avium 5,16,17) and M. kansasii 8,18) . These observations might reflect the fact that PD-related peritonitis may mostly occur through a transcutaneous infectious route, and not through a transpulmonary or translymphatic route.…”

Section: Discussionmentioning

confidence: 99%

“…There are few effective antimicrobial drugs, and their efficacy is not consistent in each case. Consequently, only a limited number of previous cases have been curable with medications 8,11,14) , and in most cases of NTM peritonitis, the PD therapies have eventually been discontinued 6,8,11,15) . Among the antimicrobial drugs, AMK 1,[6][7][8][9][10] , CAM 1,9,11,13,14) , fluoroquinolones 1,8,11,14) , and imipenem 1) have been reported to be effective in some cases with NTM peritonitis and exit-site infection.…”

Section: Discussionmentioning

confidence: 99%

Nontuberculous Mycobacterial Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

Maeda¹,

Uno²,

Yoshida³

et al. 2009

J Rural Med

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Non-tubercuous mycobacterial (NTM) infection in peritoneal dialysis (PD) patients has been rarely reported. We report a case of a 55-year-old female on continuous ambulatory peritoneal dialysis (CAPD). After a 2-year-history of recurrent exit-site infection of a PD catheter caused by Mycobacterium abscessus (M. abscessus), the patient was admitted to the hospital with signs of peritonitis. Since the same species, M. abscessus, was isolated from the CAPD effluent, multiple antibiotics were administered. However, the treatments could not relieve the symptoms of her infection. Consequently, the PD catheter was removed. Her condition gradually recovered over the course of subsequent, longterm, empirical antimicrobial therapies. NTMs, especially a rapidly growing NTM infection, have rarely been reported in PD patients and are commonly resistant to a variety of antimicrobial agents. Routine acid-fast staining is most likely helpful in promptly initiating treatment against NTM infection in PD patients. Moreover, an appropriate treatment regimen for a rapidly growing NTM infection should be established by accumulating data from cases as reported here.

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Nontuberculous Mycobacterial Infections in Continuous Ambulatory Peritoneal Dialysis Patients

Cited by 55 publications

References 16 publications

<i>Mycobacterium fortuitum </i>Peritonitis in Two Patients Receiving Continuous Ambulatory Peritoneal Dialysis

<i>Mycobacterium fortuitum </i>Peritonitis in Two Patients Receiving Continuous Ambulatory Peritoneal Dialysis

A hospital-acquired outbreak of catheter-related nontuberculous mycobacterial infection in children on peritoneal dialysis

Nontuberculous Mycobacterial Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

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