由 Mycobacteroides massiliense 引起的与腹膜透析相关的腹膜炎：首例病例及文献复习。
Peritoneal dialysis-associated peritonitis caused by Mycobacteroides massiliense: the first case and review of the literature.
机构信息
Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan.
Division of Infectious Diseases, Tottori University Faculty of Medicine, Yonago, Tottori, 683-8504, Japan.
出版信息
BMC Nephrol. 2021 Mar 12;22(1):90. doi: 10.1186/s12882-021-02297-y.
BACKGROUND
Peritoneal dialysis (PD)-associated peritonitis caused by nontuberculous Mycobacterium is rare; however, the number of cases has increased over the past decades. Mycobacteroides massiliense is a subspecies of the Mycobacteroides abscessus complex. It has different clinical characteristics compared to the other subspecies of the complex. Previous case reports of PD-associated peritonitis caused by Mycobacteroides abscessus complex have not distinguished the subspecies in detail.
CASE PRESENTATION
A 40-year-old man presented with an exit-site and tunnel infection refractory to antibiotic therapy. Peritonitis occurred after simultaneous catheter removal and reinsertion. The Mycobacteroides abscessus complex was detected in the culture of the dialysis effluent. Removal of the PD catheter combined with antibiotics, including macrolides, resulted in a good clinical course. Further analysis of multiplex PCR and the hsp65 gene sequence identified the bacterium as Mycobacteroides massiliense.
CONCLUSIONS
The Mycobacteroides abscessus complex is classified into three subspecies; Mycobacteroides abscessus, Mycobacteroides massiliense, and Mycobacteroides bolletii. These have different characteristics, particularly antibiotic susceptibility. Therefore, clear identification of the subspecies of the Mycobacteroides abscessus complex is necessary for definitive treatment.
背景
非结核分枝杆菌引起的腹膜透析（PD）相关性腹膜炎较为罕见，但在过去几十年中，其病例数有所增加。Mycobacteroides massiliense 是 Mycobacteroides abscessus 复合体的一个亚种。与该复合体的其他亚种相比，它具有不同的临床特征。先前报道的由 Mycobacteroides abscessus 复合体引起的 PD 相关性腹膜炎的病例报告并未详细区分亚种。
病例介绍
一名 40 岁男性因出口部位和隧道感染，经抗生素治疗无效而就诊。在同时拔除和重新插入导管后发生腹膜炎。在透析液的培养中检测到 Mycobacteroides abscessus 复合体。在 PD 导管拔除和使用包括大环内酯类抗生素在内的抗生素治疗后，患者的临床状况良好。进一步的多重 PCR 和 hsp65 基因序列分析确定该细菌为 Mycobacteroides massiliense。
结论
Mycobacteroides abscessus 复合体分为三个亚种：Mycobacteroides abscessus、Mycobacteroides massiliense 和 Mycobacteroides bolletii。这些亚种具有不同的特征，特别是抗生素敏感性。因此，明确鉴定 Mycobacteroides abscessus 复合体的亚种对于确定治疗方案至关重要。
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