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Peritonitis due to a mycobacterium chelonei-like organism associated with intermittent chronic peritoneal dialysis
Abstract:
Two outbreaks of peritonitis caused by a Mycobacterium chelonei-like organism--a previously unrecognized pathogen--occurred among patients receiving intermittent chronic peritoneal dialysis (CPD). In one center, five of 22 patients who had undergone CPD during a one-month period developed peritonitis caused by an M. chelonei-like organism acquired from a single contaminated automated CPD machine. In a second center, five of eight patients who had received CPD during a several-week period became infected, apparently as a result of cross-infection from contaminated machines. Seven sporadic cases of peritonitis due to an M. chelonei-like organism were also found. M. chelonei-like organisms can survive and proliferate in water and are relatively resistant to formaldehyde. Defects in the design of CPD machines and disinfection procedures were identified that may have permitted M. chelonei-like organisms to survive attempted disinfection.
Insights
Two outbreaks of peritonitis occurred in patients undergoing chronic peritoneal dialysis (CPD). A Mycobacterium chelonei-like organism, resistant to disinfection, contaminated CPD machines, leading to infections.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Peritonitis is a serious complication for patients undergoing chronic peritoneal dialysis (CPD).
- Previously unrecognized pathogens can emerge, posing significant risks to patient health.
- Contamination of dialysis equipment is a known route for infection transmission.
Purpose of the Study:
- To investigate two outbreaks of peritonitis caused by a Mycobacterium chelonei-like organism in CPD patients.
- To identify the source and transmission routes of this novel pathogen.
- To understand the organism's resistance to disinfection and its implications for CPD machine design and protocols.
Main Methods:
- Epidemiological investigation of two distinct patient cohorts experiencing peritonitis.
- Microbiological analysis to identify the causative agent, Mycobacterium chelonei-like organism.
- Examination of automated CPD machines and disinfection procedures for potential contamination sources and design flaws.
Main Results:
- Two outbreaks of peritonitis were linked to a Mycobacterium chelonei-like organism in CPD patients.
- Infections were traced to contaminated automated CPD machines in one center and cross-infection in another.
- The organism demonstrated resistance to formaldehyde and ability to proliferate in water, surviving disinfection attempts.
Conclusions:
- Mycobacterium chelonei-like organisms pose a threat to patients on CPD, causing peritonitis outbreaks.
- Defects in CPD machine design and disinfection protocols contributed to organism survival and transmission.
- Enhanced disinfection strategies and equipment modifications are crucial to prevent future infections.