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Mycobacterium abscessus exit-site infection in peritoneal dialysis patients: should we ever aim to salvage the catheter?

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Abstract

Improvements in the exit-site care for peritoneal dialysis (PD) patients have uncovered a trend for increasing incidence of rapidly growing nontuberculous mycobacterium exit-site infections (ESI). Among these, Mycobacterium abscessus is unique in terms of its high morbidity and treatment failure rates. The international society of PD guidelines encourage PD catheter removal in patients with M. abscessus peritonitis but, do not have evidence-based recommendations for the management of ESIs related to this organism. We report an unusual case in which an asymptomatic end-stage renal disease patient with multiple favorable clinical characteristics, i.e., no apparent immunodeficiency, sensitivity pattern showing possibility of treatment with multiple antibiotics, no evidence of peritonitis, and early clinical response, was treated with a 9-month combination antimicrobial regimen administered orally and intraperitoneally. Despite excellent clinical response with a resolution of the ESI, our patient relapsed quickly, within 30 days of stopping antimicrobial therapy and required PD catheter removal. Our case, taken together with available published case reports, highlights the futility of the conservative approach towards the M. abscessus ESI and makes the cases for early PD catheter removal in these patients.

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Acknowledgements

We would like to thank Dr. Kevin Fennelly (Senior Research Clinician, Laboratory of Chronic Airway Infection, Pulmonary Branch, Division of Intramural Research. National Institutes of Health) for his input on M. abscessus infection management.

Funding

A. M. Shukla reports the ongoing grant support from the Department of Veterans Affairs. The grant support is unrelated to and has no conflicts with the work published here.

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Authors and Affiliations

  1. Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL, USA

    Gajapathiraju Chamarthi, Mayanka Kamboj & Ashutosh M. Shukla

  2. North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA

    Lennox K. Archibald & Ashutosh M. Shukla

Authors
  1. Gajapathiraju Chamarthi
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  2. Mayanka Kamboj
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  3. Lennox K. Archibald
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  4. Ashutosh M. Shukla
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Correspondence to Ashutosh M. Shukla.

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Chamarthi, G., Kamboj, M., Archibald, L.K. et al. Mycobacterium abscessus exit-site infection in peritoneal dialysis patients: should we ever aim to salvage the catheter?. CEN Case Rep 10, 12–16 (2021). https://doi.org/10.1007/s13730-020-00506-5

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  • DOI: https://doi.org/10.1007/s13730-020-00506-5

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