Clinical course of peritoneal dialysis-related peritonitis due to non-tuberculosis mycobacterium - A single centre...

Area of Science:

• Nephrology
• Infectious Diseases
• Microbiology

Background:

• Peritoneal dialysis (PD)-related peritonitis caused by non-tuberculous mycobacteria (NTM) presents diagnostic challenges and is linked to high morbidity and mortality.
• The clinical course and outcomes of NTM peritonitis remain unclear, necessitating further investigation.

Purpose of the Study:

• To determine the prevalence and clinical course of peritonitis caused by NTM over a 20-year period using a kidney registry.
• To analyze demographic characteristics, microbiological data, and clinical outcomes of NTM peritonitis.

Main Methods:

• A retrospective review of patients diagnosed with NTM peritonitis between July 2000 and July 2020 at a tertiary care center.
• Examination of patient demographics, causative NTM species, antibiotic sensitivities, treatment responses, and patient outcomes, including catheter survival and mortality.

Main Results:

• Twenty-seven patients with NTM peritonitis were identified, commonly presenting with abdominal pain and cloudy peritoneal fluid. Exit site infection and prior antibiotic use were frequent comorbidities.
• Mycobacterium chelonae and Mycobacterium fortuitum were the most common NTM species, often exhibiting resistance to fluoroquinolones and cefoxitin but sensitivity to amikacin.
• None achieved primary response at 10 days; 20 cases necessitated Tenckhoff catheter removal, with only two patients resuming PD. Eight patients died, but exit site infection and prior antibiotic use did not correlate with poorer outcomes.

Conclusions:

• NTM peritonitis is challenging to treat, often involving delayed diagnosis.
• Refractory peritonitis with negative cultures or poor response to standard antibiotics should raise suspicion for NTM infection.
• Prompt catheter removal and consultation with NTM infection specialists are recommended for suspected cases.