South West Thames Renal & Transplantation Unit, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK.
Department of Microbiology, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK.
BMC Nephrol. 2020 Nov 17;21(1):491. doi: 10.1186/s12882-020-02146-4.
Peritoneal dialysis (PD) is a form of therapy for end-stage kidney disease (ESKD), and peritonitis is a known complication. Mycobacterium (M) species associated peritonitis in PD patients is uncommon. Our experience of managing PD associated peritonitis caused by M abscessus in a middle-aged man with ESKD due to focal segmental glomerulosclerosis is shared in this article with a review of the literature on this condition.
A 49-year old man presented to our unit with symptoms of peritonitis and cloudy PD effluent. Initial analysis of PD fluid showed Gram stain was negative, with no organism grown. Empirical PD peritonitis treatment with intra-peritoneal antibiotics did not improve his symptoms and he required intravenous antibiotics, PD catheter removal and a switch to haemodialysis. Cultures of the PD fluid later grew M abscessus, and the antibiotic regimen was changed appropriately, leading to clinical improvement.
M abscessus associated peritonitis in PD patients is rare. It needs to be borne in mind when clinical improvement is not seen with standard broad-spectrum antibiotics, especially in situations where the PD fluid is initially deemed to be culture negative. PD fluid samples should be sent for acid-fast bacillus and if detected, should be further analysed with genome-wide sequencing to confirm the species of the Mycobacterium. Prompt removal of the catheter with peritoneal washout is critical for clinical improvement.
腹膜透析 (PD) 是治疗终末期肾病 (ESKD) 的一种方法，腹膜炎是一种已知的并发症。与 PD 患者相关的分枝杆菌 (M) 相关腹膜炎并不常见。我们分享了一名中年男性因局灶节段性肾小球硬化症导致 ESKD 后并发 M abscessus 引起的 PD 相关性腹膜炎的管理经验，并对该疾病的文献进行了回顾。
一名 49 岁男性因腹膜炎和混浊 PD 流出液就诊于我院。PD 液的初始分析显示革兰氏染色阴性，未培养出任何微生物。经验性 PD 腹膜炎治疗采用腹腔内抗生素，但他的症状并未改善，需要静脉内抗生素、PD 导管拔除和切换至血液透析。PD 液培养后来培养出 M abscessus，相应地调整了抗生素治疗方案，患者的临床症状得到改善。
PD 患者的 M abscessus 相关性腹膜炎较为罕见。当标准广谱抗生素治疗未见临床改善时，尤其是 PD 液最初被认为培养阴性时，应考虑到这种情况。应将 PD 液样本送检抗酸杆菌，如果检测到，应进一步进行全基因组测序分析以确认分枝杆菌的种类。及时拔除导管并进行腹膜冲洗对于临床改善至关重要。
