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Simultaneous catheter removal and reinsertion, is it acceptable in M. abscessus exit site infection?

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Abstract

In recent times, increasing reports of exit site infections (ESI) in peritoneal dialysis (PD) patients related to environmentally acquired atypical organisms, such as nontuberculous mycobacterium (NTM), have been reported in the literature. Among these NTM, Mycobacterium abscessus (M. abscessus) is unique and is associated with high morbidity and treatment failure rates. The international society of PD guidelines suggests individualizing therapeutic options for NTM-related ESI. Moreover, the guidelines encourage simultaneous catheter removal and reinsertion (SCRR) in isolated ESI, not responding to antimicrobial therapy to avoid PD interruptions. Physicians should be aware of the limitations of such approaches as delay in appropriate PD catheter intervention can be fraught with complications in patients with M. abscessus ESI. We report an M. abscessus ESI in a PD patient who underwent SCRR in conjunction with targeted antimicrobial therapy, and developed M. abscessus peritonitis requiring PD catheter removal and conversion to hemodialysis. The patient also developed ESI at the new exit site long after the PD catheter was removed, requiring prolonged antimicrobial therapy. Our case, taken together with available published case reports, highlights the futility of the SCRR approach towards the M. abscessus ESI and makes the cases for early PD catheter removal in these patients.

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

    Ashutosh M. Shukla

  2. Division of Nephrology, Hypertension and Transplantation, University of Florida, 1600 Archer Road, Gainesville, FL, 32610, USA

    Gajapathiraju Chamarthi, Dhruv Modi & Ashutosh M. Shukla

  3. Division of Organ Transplantation, Department of Surgery, University of Florida, Gainesville, FL, USA

    Kenneth Andreoni

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  1. Gajapathiraju Chamarthi
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  2. Dhruv Modi
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  3. Kenneth Andreoni
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  4. Ashutosh M. Shukla
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Correspondence to Ashutosh M. Shukla.

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Chamarthi, G., Modi, D., Andreoni, K. et al. Simultaneous catheter removal and reinsertion, is it acceptable in M. abscessus exit site infection?. CEN Case Rep 10, 483–489 (2021). https://doi.org/10.1007/s13730-021-00593-y

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  • DOI: https://doi.org/10.1007/s13730-021-00593-y

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