Nontuberculous mycobacteria infections of peritoneal dialysis patients: A multicenter study. Issue 3 (May 2021)

• Record Type: Journal Article
• Authors: Bnaya, Alon; Wiener-Well, Yonit; Soetendorp, Hila; Einbinder, Yael; Paitan, Yossi; Kunin, Margarita; Tanasiychuk, Tatiana; Kushnir, Daniel; Kruzel-Davila, Etty; Gershkovitz, Regina; Rosenberg, Roza; Bloch, Aharon; Doviner, Victoria; Assous, Marc V; Peretz, Orly; Shavit, Linda; Ben-Chetrit, Eli
• Is Part Of: Peritoneal dialysis international. Volume 41:Issue 3(2021)
• Page Start: 284
• Page End: 291
• Publication Date: 2021-05
• Subjects: Exit-site infection -- nontuberculous mycobacteria -- peritonitis; Peritoneal dialysis -- Periodicals; Continuous ambulatory peritoneal dialysis -- Periodicals; 617.461059
• DOI: 10.1177/0896860820923461
• Languages: English
• ISSNs: 0896-8608

Abstract

Objectives: Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients. Methods: All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed. Results: Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52–76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or Corynebacterium spp. was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD. Conclusions: Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp ., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.