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Kidney Week

Abstract: SA-PO632

Peritoneal Dialysis-Related Mycobacterium abscessus Infections: A Case Series

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Abdelkader, Ahmed I. Kamal, Medical University of South Carolina, Charleston, South Carolina, United States
  • Nicholson, Austin C., Medical University of South Carolina, Charleston, South Carolina, United States
  • Vilayet, Salem, Medical University of South Carolina, Charleston, South Carolina, United States
  • Dorman, Susan, Medical University of South Carolina, Charleston, South Carolina, United States
  • Ullian, Michael E., Medical University of South Carolina, Charleston, South Carolina, United States
Background

Catheter-associated infections are an important cause of morbidity and catheter loss in people using peritoneal dialysis (PD). Mycobacterium abscessus is a rapidly growing non-tuberculous mycobacterium (NTM) that has innate antimicrobial resistance. M. abscessus is an uncommon etiology of PD catheter associated infections, with only a handful of cases reported and only 2 cases reported in USA. Thus, there is a lack of evidence-based guidance on management of M. abscessus PD catheter infections. During routine clinical care, we encountered several patients with PD related infections due to M. abscessus. We sought to determine risk factors for M. abscessus PD catheter associated infections and describe treatment outcomes.

Methods

This is a retrospective study in which medical records from one 700-bed tertiary care hospital and one regional dialysis center were reviewed. Information was abstracted to a study-specific case report form. Epidemiological, clinical characteristics, M. Abscessus complex subspecies, managements and fate of PD were explored. This study was approved by relevant IRBs.

Results

We identified 7 patients diagnosed with M. abscesses PD catheter infection. Among these 7 patients, 4 (57%) presented with symptoms suggestive of peritonitis and 3 (43%) with exit site infections (ESI) / tunnel infections. 7% were males (4/7) with median age of 42 years (range 42-88). Original kidney disease was diabetic nephropathy in 57% (4/7) and mean time on PD before developing NTM infection was 20.5 months. Subspecies were identified in 6 (85%) and revealed 4 (57%) with abscessus and 2 (28%) with massiliense. 5 patients (72%) were managed with upfront PD catheter removal and antibiotics with good outcomes. PD catheter salvage was attempted in two patients (28%) initially presenting with ESI. One of these patients progressed over a year to peritonitis and tunnel abscess due to M. abscessus despite continued antibiotics. The other was shifted to hemodialysis (with PD catheter removal) after persistent M. abscessus ESI in the context of antibiotic intolerances.

Conclusion

M. abscessus is an important cause of PD catheter-associated infections. Management of peritonitis and tunnel infections requires catheter removal and prolonged antimicrobial therapy. Catheter removal should be considered in people with ESI.