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Nontuberculous mycobacteria infections of peritoneal dialysis patients: A multicenter study
Alon Bnaya1, Yonit Wiener-Well2, Hila Soetendorp3
1Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
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.
Insights
Nontuberculous mycobacteria (NTM) infections in peritoneal dialysis (PD) patients are challenging to diagnose. Look for negative cultures or specific bacteria, as these may indicate NTM infection requiring prompt treatment.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Nontuberculous mycobacteria (NTM) infections present diagnostic difficulties in patients undergoing peritoneal dialysis (PD).
- Identifying specific clinical and microbiological indicators is crucial for early NTM detection in PD patients.
Purpose of the Study:
- To identify clinical and microbiological findings suggestive of NTM infection in adult PD patients.
- To improve the diagnostic accuracy and timeliness of NTM infection identification in this vulnerable population.
Main Methods:
- Retrospective analysis of NTM exit-site infection (ESI) and peritonitis cases over a decade in eight Israeli medical centers.
- Inclusion of clinical, microbiological, and treatment outcome data for 30 identified PD patients.
Main Results:
- 16 patients had ESI and 14 had peritonitis; median age was 65.
- Common findings included exit-site discharge (ESI) and cloudy PD fluid (peritonitis).
- 47% had negative cultures prior to NTM diagnosis, and 30% showed diphtheroids or Corynebacterium spp. 43% received prior antibiotics.
Conclusions:
- Culture-negative peritonitis, isolation of diphtheroids/Corynebacterium spp., prior antibiotics, or refractory infection warrant consideration of NTM.
- Catheter removal and prolonged antimicrobial therapy are generally recommended.
- Continuation of PD may be possible in select ESI cases.
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