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Mycobacterium Abscessus: A Case Report Of Peritoneal Dialysis Peritonitis
Peritonitis due to mycobacterium abscessus in peritonea ldia l)sis (1'1)) pati ents is rare. Mycobacterium ahsccssus is a rapidly ~nlwin~ mycchacteriumtRGM). I{G!\1are opportu nistic pathogens. rnosll) affecting compr omised patient s as those with end stage renal faijure, who received continuous ambulatory peritoneal dialy sis tCAPI)). However; "hen it occurs. 1'1)catheter removal is required in most cases becau se ofn:sista nce 10aufihintic therapy, We report IIClIS£, ofMycobacterium ubsc essu s peritomtis within a week after PI) cathete r insertkm. The mycobacteria were identilied a s 1\1. abscessus h) rpo!l gene and due to drug resistance. IJI)catheter remov ed. Culture negat ive peritonitis should alert nephroknnsts to look for at}pical mycobacteria. Keywords: Peritonitis, mycobacterium a bscesses, Rapidly growing mycobacterium ,
Renal Replacement Therapy, 2018
Background: Peritoneal dialysis (PD)-associated peritonitis caused by nontuberculous mycobacteria (NTM), including Mycobacterium abscessus (M. abscessus), is a rare but serious complication that forces PD to be withdrawn. Several cases of peritonitis by NTM have been reported, and optimal treatment has not yet been established. Case presentations: We report two cases of PD-associated peritonitis caused by M. abscessus. In both cases, peritonitis developed after an exit-site infection. The patients did not have any typical signs of peritonitis or an elevated nucleated cell count of the dialysis effluent in the early phase. In addition, effluent cultures were negative at admission in both cases, although M. abscessus was identified in effluent cultures in the late phase. One patient recovered after the PD catheter was removed, and multi-antibiotic treatment was administered for 6 months. The other patient subsequently developed encapsulating peritoneal sclerosis (EPS) 16 months after the onset of infection. In addition, the EPS was complicated by intestinal perforation into infected ascites. The infection resolved with antibiotic treatment and octreotide administration to diminish bowel leakage into the infected cavity. Conclusions: The combination of amikacin, clarithromycin, and imipenem/cilastatin with PD catheter removal may be effective for the treatment of M. abscessus PD-associated peritonitis. The prognosis of M. abscessus-induced peritonitis is generally poor, and it is of note that residual encapsulated ascites in the peritoneal cavity after treatment may increase the risk of infection recurrence or EPS development.
Journal of Health Sciences and Medicine, 2022
Aim: Although the guidelines recommend arteriovenous fistula (AVF) primarily as vascular access in hemodialysis patients, tunneled catheter (TC) use is gradually increasing. TCs are associated with an increased risk of infection. TC infections can cause many metastatic infectious complications such as infective endocarditis (IE), spondylodiscitis (SpD), and paravertebral abscess. This study aimed to determine the frequency, risk factors, and prognosis of metastatic infectious complications in patients admitted to our hospital with TC infections. Material and Method: Patients with TCs hospitalized to the Nephrology unit of Ondokuz Mayıs University Hospital between January 1, 2015, and January 1, 2020, with catheter infection, were included in the study. Demographic, clinical, and microbiological information was obtained from the patients' medical records retrospectively. Metastatic infectious complications were defined as IE, SpD, paravertebral or epidural abscess, and septic embolisms in any focus. Binary logistic regression analyzes were used to identify risk factors for metastatic infectious complications. Results: One hundred and forty-eight catheter episodes were included in the study. Eighty-seven (58.8%) of the patients were women. Metastatic infectious complications developed in 22 (14.9%) of the patients. Of these, ten patients had IE, ten patients had SpD, and two patients had both IE and SpD. Coagulase-negative staphylococci was obtained as pathogenic microorganism in most cases (9/22, 49%). Patients with infectious complications had higher length of hospital stay [46.5 (10-171) vs 18 (6-92); p<0.001], and higher rates of sepsis (50% vs 16.7%; p<0.001), need for intensive care unit (36.4% vs 12.7%; p=0.005), and death (36.4% vs 11.9%; p=0.003). In multivariate binary logistic regression analysis, diabetes mellitus (DM) [OR: 7,813; 95% CI (2.05-29,783); p=0.003] and catheter duration [OR: 1.002; 95% CI (1-1,003); p=0.009] were identified as risk factors associated with metastatic infectious complications. Conclusion: Metastatic infectious complications are associated with significant morbidity and mortality in hemodialysis patients. Long catheter duration and the presence of DM are risk factors for infectious complications. As recommended in international guidelines, minimizing the use of catheters and preventing the development of catheter infection by paying attention to basic hygiene rules, especially in diabetic patients, will help prevent these serious complications.
Catheter Infections in Insulin-Dependent Diabetics on Continuous Ambulatory Peritoneal Dialysis
We compared a group of 60 insulin-dependent diabetics maintained on CAPO with 60 nondiabetic matched controls to determine if the diabetic patients were at increased risk for catheter-related infections. Although catheter infection rates were 17% higher in the diabetics (1.4/year versus 1.2/year in nondiabetics), time to first catheter infection was not different between the groups (p=0.6). Rates of peritonitis, peritonitis associated with catheter infection, multiple catheter infection, and catheter removal were also similar among the diabetics and controls. S. aureus caused 52% (42/81) of the catheter infections in the diabetics and 60% (35/58) in the controls. More catheter infections in the nondiabetics versus the diabetics lacked drainage or resulted in sterile cultures (17/75 versus 7/88 respectively, p≤0.01 ), but the significance of this finding is uncertain. In conclusion, we did not find insulin-dependent diabetes mellitus to be a statistically significant risk factor for catheter-related infections.
Determinants of catheter loss following continuous ambulatory peritoneal dialysis peritonitis
Peritoneal Dialysis …, 2008
microbiological determinants of PD catheter loss included fungi (p < 0.001), anaerobes (p = 0.018), and Pseudomonas sp (borderline significance: p = 0.095). ♦ ♦ ♦ ♦ ♦ Conclusion: PD catheter loss as a consequence of peritonitis is related primarily to hypoalbuminemia, longer duration of PD effluent leukocyte count remaining above 100/µ µ µ µ µL, the etiologic source of the infection, and the organism causing the infection. Peritonitis associated with concomitant tunnel or exit-site infections and abdominal catastrophes were more likely to proceed to PD catheter loss. The microbiological determinants of PD catheter loss in the present study included polymicrobial infections caused by Enterobacteriaceae as well as monomicrobial pseudomonal, anaerobic, and fungal infections.
Peritoneal dialysis infections: An opportunity for improvement
2014
Peritoneal dialysis (PD) cathetereassociated infections remain a challenging cause of technique failure. Patient training and preventive measures are key elements in the management of infection rates. Twenty-seven of the 167 PD catheter transfer sets analyzed (19%) yielded a positive microbial culture (58% gram-negative bacteria). These results show that subclinical contamination, particularly from environmental gram-negative bacteria, is a potential hazard, indicating the need for a protocol for regular transfer set changes.