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Kidney Week

Abstract: SA-PO635

Prognosis and Treatment of Peritoneal Dialysis-Associated Infection by Nontuberculous Mycobacteria

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

  • Kadota, Nozomi, St.Luke's International Hospital, Tokyo, Japan
  • Ito, Yugo, St.Luke's International Hospital, Tokyo, Japan
  • Konishi, Kasumi, St.Luke's International Hospital, Tokyo, Japan
  • Fujimaru, Takuya, St.Luke's International Hospital, Tokyo, Japan
  • Taki, Fumika, St.Luke's International Hospital, Tokyo, Japan
  • Nagahama, Masahiko, St.Luke's International Hospital, Tokyo, Japan
  • Nakayama, Masaaki, St.Luke's International Hospital, Tokyo, Japan
Background

Nontuberculous Mycobacterium (NTM) can lead to infections related to peritoneal dialysis (PD) catheters, defined as exit site infection and tunnel infection, and PD related peritonitis. Current guideline lacks clarity regarding the indication for catheter removal and the optimal duration of treatment for these infections. Therefore, the aim of this literature review is to analyze the accurate treatment approaches and prognosis associated with NTM-related PD catheter infections and peritonitis.

Methods

We conducted a literature review of published cases of PD catheter-related infection and peritonitis by NTM in PubMed, Embase, and Ichu-shi databases up to August 2022.

Results

A total of 362 cases were included in the analysis. Among these cases, 226 (62%) were male, with the mean age of 57 years. Diabetic nephropathy accounted for 22% of cases as the most common cause of end-stage kidney disease (ESKD). Mycobacterium abscessus was identified as the most prevalent pathogen, found in 38% of cases. The distribution of cases was as follows: 39% categorized as catheter-related infection alone, 26% as peritonitis alone, and 25% as both catheter-related infection and peritonitis. Only 57% of cases yielded positive NTM cultures on the initial attempt. In 18% of cases, other bacteria, mainly Corynebacterium or diphtheria, were identified in the initial culture, while the first bacterial culture was negative in 24% of cases. Antibiotics alone were used to manage 43% of patients, while 44% eventually required catheter removal. The average duration of antibiotics was 4.8 months. Notably, six cases of peritonitis resulted in death without catheter removal.

Conclusion

This case series represents the largest sample size in NTM-related catheter-related infection and peritonitis. Early submission of acid-fast bacilli smear and culture should be considered, especially when bacterial cultures are either gram positive rods or negative. Catheter removal may be considered as the appropriate management at the early stage of NTM infection.