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Mycobacterium fortuitum peritonitis in two patients receiving continuous ambulatory peritoneal dialysis
1Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University Medical Center, Washington, DC, USA.
Abstract:
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.
Insights
Two patients with persistent peritonitis were successfully treated by removing the dialysis catheter and using antibiotics tailored to Mycobacterium fortuitum sensitivities. This rapidly growing nontuberculous mycobacterium caused resistant infections in immunocompromised patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Peritonitis is a serious complication in patients undergoing peritoneal dialysis.
- Nontuberculous mycobacteria (NTM), including rapidly growing species like Mycobacterium fortuitum, can cause refractory peritonitis.
- Risk factors for M. fortuitum peritonitis include end-stage renal disease (ESRD), immunosuppression, and prior antibiotic exposure.
Observation:
- Two cases of non-resolving peritonitis were observed despite standard treatment protocols.
- Peritoneal effluent cultures identified Mycobacterium fortuitum, a Group IV (Runyon classification) rapidly growing NTM.
- Isolates demonstrated resistance to conventional antibiotics typically used for peritonitis.
Findings:
- Both patients presented with M. fortuitum peritonitis, a challenging infection due to antimicrobial resistance.
- Treatment failure with standard protocols highlighted the need for targeted therapy.
- Successful outcomes were achieved through catheter removal and antibiotics guided by drug susceptibility testing.
Implications:
- Catheter removal is crucial for treating M. fortuitum peritonitis in dialysis patients.
- Antimicrobial susceptibility testing is essential for guiding effective treatment of NTM peritonitis.
- Understanding risk factors and environmental exposures can aid in preventing M. fortuitum peritonitis.