Nontuberculous mycobacteria infections of peritoneal dialysis patients: A multicenter study

被引:9
作者
Bnaya, Alon [1 ]
Wiener-Well, Yonit [2 ]
Soetendorp, Hila [3 ]
Einbinder, Yael [4 ]
Paitan, Yossi [5 ]
Kunin, Margarita [6 ]
Tanasiychuk, Tatiana [7 ]
Kushnir, Daniel [7 ]
Kruzel-Davila, Etty [8 ]
Gershkovitz, Regina [9 ]
Rosenberg, Roza [10 ]
Bloch, Aharon [11 ]
Doviner, Victoria [12 ]
Assous, Marc, V [13 ]
Peretz, Orly [1 ]
Shavit, Linda [1 ]
Ben-Chetrit, Eli [2 ]
机构
[1] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, Inst Nephrol, POB 3235, IL-91031 Jerusalem, Israel
[2] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, Infect Dis Unit, Jerusalem, Israel
[3] Tel Aviv Univ, Sourasky Med Ctr, Dept Nephrol, Tel Aviv, Israel
[4] Tel Aviv Univ, Meir Med Ctr, Dept Nephrol, Kefar Sava, Israel
[5] Tel Aviv Univ, Meir Med Ctr, Dept Clin Microbiol & Immunol, Kefar Sava, Israel
[6] Tel Aviv Univ, Sheba Med Ctr, Inst Nephrol & Hypertens, Ramat Gan, Israel
[7] Technion Israel Inst Technol, Carmel Med Ctr, Dept Nephrol, Haifa, Israel
[8] Technion Israel Inst Technol, Dept Nephrol & Hypertens, Rambam Hlth Care Campus, Haifa, Israel
[9] Tel Aviv Univ, Hillel Yaffe Med Ctr, Israel Inst Nephrol & Hypertens, Hadera, Israel
[10] Tel Aviv Univ, Assaf Harofeh Med Ctr, Div Nephrol, Beer Yaagov, Israel
[11] Hebrew Univ Jerusalem, Hadassah Med Ctr, Dept Nephrol & Hypertens, Jerusalem, Israel
[12] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, Dept Pathol, Jerusalem, Israel
[13] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, Clin Microbiol Lab, Jerusalem, Israel
来源
PERITONEAL DIALYSIS INTERNATIONAL | 2021年 / 41卷 / 03期
关键词
Exit-site infection; nontuberculous mycobacteria; peritonitis; EXIT-SITE INFECTION; TUBERCULOUS PERITONITIS; FORTUITUM; PREVENTION;
D O I
10.1177/0896860820923461
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients. Methods: All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed. Results: Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52-76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or Corynebacterium spp. was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD. Conclusions: Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.
引用
收藏
页码:284 / 291
页数:8
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