Mycobacterium Exit Site Infection in a Peritoneal Dialysis Patient
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Dodbiba, Kristi, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Hilburg, Rachel, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Mycobacterium Fortuitum (M.Fortuitum) is a rare form of nontuberculous infection that uncommonly affects peritoneal dialysis (PD) patients. Mycobacterial peritonitis has a high rate of morbidity and mortality. We present a case of a patient with Mycobacterium exit site infection which led to PD catheter removal, transition to intermittent hemodialysis, eradication of infection and reinsertion of PD catheter to successfully reinitiate PD.
A 41-year-old man with end stage kidney disease on PD (catheter placed 2021), hypertension, and diabetes mellitus, presented to outpatient PD clinic in July 2022 with purulent drainage from the PD catheter exit site. Prior to this in April 2022 he was treated for coagulase negative staphylococcus peritonitis with intraperitoneal cefazolin and fungal prophylaxis. In July 2022, exit site culture was positive for AFB with speciation to M. Fortuitum. Peritoneal fluid cultures were negative. He was initiated on ciprofloxacin, clarithromycin and fungal prophylaxis. Due to ongoing purulent drainage, he underwent surgical evaluation with PD catheter revision and exit site debridement. He was also referred to Infectious Disease. Exit site culture again grew M. Fortuitum that was macrolide resistant. He was switched to doxycycline and ciprofloxacin. CAT scan showed no drainable fluid collection. Due to sustained exit site infection, he underwent PD catheter removal and transitioned to intermittent hemodialysis via tunneled dialysis catheter. After 4 months of antibiotic therapy post-PD catheter removal, CAT scan confirmed no evidence of fluid collection, at which time antibiotics were concluded. A month after he was infection free, he underwent new PD catheter placement and transitioned back to PD, with plan for re-activation on the transplant list.
Our patient had resolution of exit site infection and restarted PD after a long course of antibiotics and removal of the initial PD catheter. This case not only advocates for early removal of PD catheter and foregoing exit site revision, but also illustrates the importance of dual therapy for mycobacterial infection treatment. Fortunately, this patient never progressed to mycobacterial peritonitis. Lastly, this case demonstrates the importance of multidisciplinary collaboration between nephrology, infectious disease, and surgery to safely and quickly eradicate infection.