Imam Omar, Al-Zubaidi Khaled, Janahi Mohammad, Imam Abubakr, Leghrouz Bassil, Dobson Simon, Sundararaju Sathyavathi, Tsui Kin Ming, Hasan Mohammad Rubayet, Perez-Lopez Andres
Division of Pediatric Infectious Diseases, Doha, Qatar.
Department of Infection Prevention and Control, Sidra Medicine, Doha, Qatar.
Open Forum Infect Dis. 2020 Nov 27;8(1):ofaa579. doi: 10.1093/ofid/ofaa579. eCollection 2021 Jan.
Peritoneal dialysis (PD)-associated peritonitis constitutes a major complication associated with the procedure. PD-associated peritonitis caused by nontuberculous mycobacteria, usually as a result of an infection related to the PD catheter, has been reported in adults and is associated with significant complications and poor outcome. The management of PD-associated peritonitis caused by is particularly challenging because this species is resistant to many antimicrobials commonly used to treat mycobacterial species. We present here the second reported case of PD-associated peritonitis caused by in children. Our patient was a 9-year-old boy with end-stage renal disease (ESRD) who presented with suspected peritonitis, and his PD fluid cultures eventually grew . The patient received a 3-week course of triple therapy with clarithromycin, amikacin, and meropenem in addition to PD catheter removal. The infection completely resolved even though a susceptibility report at the end of treatment revealed that the isolate was resistant to clarithromycin and had decreased susceptibility to carbapenems. Our observations suggest that PD catheter removal is important in PD-associated peritonitis caused by in children and that more studies are needed to define the optimal length of treatment.
腹膜透析（PD）相关腹膜炎是该治疗方法的主要并发症。非结核分枝杆菌引起的PD相关腹膜炎通常是由与PD导管相关的感染导致，在成人中已有报道，且与严重并发症及不良预后相关。由该菌引起的PD相关腹膜炎的治疗极具挑战性，因为该菌对许多常用于治疗分枝杆菌的抗菌药物耐药。我们在此报告第二例儿童由该菌引起的PD相关腹膜炎病例。我们的患者是一名9岁患有终末期肾病（ESRD）的男孩，因疑似腹膜炎就诊，其PD液培养最终培养出该菌。除拔除PD导管外，患者接受了为期3周的克拉霉素、阿米卡星和美罗培南三联治疗。尽管治疗结束时的药敏报告显示分离株对克拉霉素耐药且对碳青霉烯类药物敏感性降低，但感染仍完全消退。我们的观察结果表明，对于儿童由该菌引起的PD相关腹膜炎，拔除PD导管很重要，且需要更多研究来确定最佳治疗时长。
