Mycobacterium abscessus exit-site infection in peritoneal dialysis patients: should we ever aim to salvage the...

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritoneal dialysis (PD) exit-site infections (ESI) caused by rapidly growing nontuberculous mycobacteria, particularly Mycobacterium abscessus, are increasing.
• Mycobacterium abscessus infections are associated with high morbidity and treatment failure rates.
• Current guidelines lack evidence-based recommendations for managing M. abscessus ESIs, though PD catheter removal is advised for M. abscessus peritonitis.

Observation:

• A case of an asymptomatic end-stage renal disease patient with favorable characteristics (no immunodeficiency, susceptible to multiple antibiotics, no peritonitis, early clinical response) was treated conservatively.
• The patient received a 9-month combination antimicrobial regimen (oral and intraperitoneal).
• Despite initial clinical resolution of the exit-site infection, the patient experienced a rapid relapse within 30 days of therapy cessation, necessitating PD catheter removal.

Findings:

• Conservative management with prolonged antimicrobial therapy for Mycobacterium abscessus exit-site infections in PD patients can lead to relapse.
• Early PD catheter removal may be a more effective strategy for managing M. abscessus ESIs, even in cases with favorable initial response.

Implications:

• The findings suggest that a conservative approach to M. abscessus ESI in PD patients is often futile.
• Early PD catheter removal should be strongly considered for M. abscessus exit-site infections to prevent relapse and improve patient outcomes.
• Further research is needed to establish evidence-based guidelines for managing these challenging infections.