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Abstract: PO1281

A Rare Cause of Peritoneal Dialysis-Associated Peritonitis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Jheeta, Anup S., St Helier Hospital, Carshalton, United Kingdom
  • Rangaiah, Jayakeerthi, St Helier Hospital, Carshalton, United Kingdom
  • Clark, John, St Helier Hospital, Carshalton, United Kingdom
  • Makanjuola, David, St Helier Hospital, Carshalton, United Kingdom
  • Somalanka, Subash, St Helier Hospital, Carshalton, United Kingdom
Introduction

Peritoneal dialysis (PD)-associated peritonitis (PDaP) caused by the non-tuberculous mycobacterium (M) species Mycobacterium abscessus (MA) is emerging as a severe infective complication of PD. MA causes disseminated infection in immunocompromised individuals and is resistant to classical anti-tuberculous drugs and antibiotics. Diagnosis of MA PDaP is often delayed, as it presents as a culture −ve peritonitis. Successful treatment requires a PD catheter (PDC) removal in addition to multiple anti-microbial therapies and results in a permanent switch to haemodiafiltration (HDF).

Case Description

A 50-yr-old ♂, presented with fever, abdominal pain and cloudy PD fluid (PF) after returning from a holiday. He was systemically well apart from a tender abdomen. PD exit site and tunnel appeared normal. CRP was 80.7 mg/L (0-5 mg/L) and WCC was 6.0 x 109/L. Empirical treatment for PDaP was commenced with intra-peritoneal Vancomycin + Gentamicin. Microscopy of the PF showed a WCC of 155/µL and −ve Gram stain. MA was cultured and confirmed by whole-genome sequencing. Clarithromycin, Amikacin, Imipenem + Cilastatin and Tigecycline were commenced. Emergency PDC removal with a peritoneal washout was performed. He was switched to HDF. Day16, Clarithromycin was stopped due to a prolonged QTc interval. Day26, he developed hepatopathy that resolved after cessation of Tigecycline. Amikacin + Imipenem was continued for 5 months and switched to Amikacin + Linezolid. He developed Amikacin-induced tinnitus despite therapeutic dose monitoring. He completed 20 weeks of therapy and remains free of infection.

Discussion

MA is an environmental M that is found in water, soil, dust and is related to M causing tuberculosis and leprosy. It is known to contaminate devices and medical products. It causes lung infections in the immunocompromised. Our patient had no such history. The duration between PDC insertion and this episode was 2 yrs, making this an unlikely cause. The history did not reveal any reason for contracting this organism. The optimum treatment duration and selection of anti-microbial therapy in the management of MA PDaP is unclear, primarily due to the paucity of confirmed cases and variability of the treatment regimens. PDC removal and peritoneal washout remain the mainstay of treatment. Our case highlights MA as an emerging organism in PDaP and physicians should be aware of it.