Peritoneal dialysis-associated infection caused by Mycobacterium abscessus: a case report

• Published in: BMC nephrology Vol. 19; no. 1; pp. 341 - 7
• Main Authors: Yoshimura, Ryuichi, Kawanishi, Miharu, Fujii, Shungo, Yamauchi, Aska, Takase, Kentaro, Yoshikane, Kaori, Egawa, Masahiro, Shiina, Hiroaki, Ito, Takafumi
• Format: Journal Article
• Language: English
• Published: London BioMed Central 29.11.2018; BioMed Central Ltd; BMC
• Subjects: Acids; Antibiotics; Blood; Case Report; Case Reports; Catheters; Coagulase; Drug resistance; Effluents; Hemodialysis; Infection; Infections; Internal Medicine; Medicine; Medicine & Public Health; Methicillin; Mycobacterium; Mycobacterium abscessus; Nephrology; Patients; Peritoneal dialysis; Peritoneum; Peritonitis; Tuberculosis; Wound infection; Infection; Peritoneal dialysis; Peritonitis; Mycobacterium abscessus
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-018-1148-2

Background Peritoneal dialysis (PD)-associated infection caused by Mycobacterium spp. is rare. Mycobacterium abscessus is one of the most resistant acid-fast bacteria, and treatment is also the most difficult and refractory. Thus, we report a case of PD-associated peritonitis caused by Mycobacterium abscessus that was difficult to treat and led to PD failure. Case presentation We recently encountered a 56-year-old man who developed PD-associated infection. We initially suspected exit-site infection (ESI) and tunnel infection (TI) caused by methicillin-resistant coagulase-negative Staphylococcus . However, antibiotic therapy did not provide any significant improvement. Thus, we performed simultaneous removal and reinsertion of a PD catheter at a new exit site. The patient subsequently developed peritonitis and Mycobacterium abscessus was detected in the peritoneal effluent. Thus, the reinserted catheter was removed, hemodialysis was started, and the patient was eventually discharged. Conclusions In cases of refractory ESI or TI, it is important to consider non-tuberculous mycobacteria as the potentially causative organism. Even if acid-fast bacterial staining is negative or not performed, detection of Gram-negative bacillus may lead to suspicion and early identification of Mycobacterium spp. In PD-associated infection by Mycobacterium abscessus , catheter removal is necessary in many cases. Simultaneous removal and reinsertion of the catheter is not recommended, even in cases of ESI or TI. Reinsertion should only be attempted after complete resolution of peritoneal symptoms. After removal of the catheter, careful follow-up is necessary, paying attention to complications such as wound infection, peritonitis, and ileus. In addition, the selection and treatment period of antibiotics in PD-associated infection by Mycobacterium abscessus remains unclear, and it is an important topic for future discussion.