Alon Bnaya1, Yonit Wiener-Well2, Hila Soetendorp3, Yael Einbinder4, Yossi Paitan5, Margarita Kunin6, Tatiana Tanasiychuk7, Daniel Kushnir7, Etty Kruzel-Davila8, Regina Gershkovitz9, Roza Rosenberg10, Aharon Bloch11, Victoria Doviner12, Marc V Assous13, Orly Peretz1, Linda Shavit1, Eli Ben-Chetrit2. 1. Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel. 2. Infectious Diseases Unit, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel. 3. Department of Nephrology, Sourasky Medical Center, Affiliated with the Tel Aviv University, Israel. 4. Department of Nephrology, Meir Medical Center, Kfar Saba, Affiliated with the Tel Aviv University, Israel. 5. Department of Clinical Microbiology and Immunology, 37253Meir Medical Center, Kfar Saba, Affiliated with the Tel Aviv University, Israel. 6. Institue of Nephrology and Hypertension, 26744Sheba Medical Center, Ramat Gan, Affiliated with the Tel Aviv University, Israel. 7. Department of Nephrology, 37255Carmel Medical Center, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel. 8. Department of Nephrology and Hypertension, 58878Rambam Health Care Campus, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel. 9. Israel Institute of Nephrology and Hypertension, 26736Hillel Yaffe Medical Center, Hadera, Affiliated with the Tel Aviv University, Israel. 10. Division of Nephrology, 37256Assaf Harofeh Medical Center, Be'er Ya'akov, Affiliated with the Tel Aviv University, Israel. 11. Department of Nephrology and Hypertension, 58884Hadassah Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel. 12. Department of Pathology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel. 13. Clinical Microbiology Laboratory, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel.
Abstract
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.
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.