Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan.
Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
BMC Nephrol. 2024 Nov 28;25(1):432. doi: 10.1186/s12882-024-03841-2.
The number of peritoneal dialysis (PD) catheter-related infections and peritonitis caused by nontuberculous mycobacteria (NTM) has been increasing. Nonetheless, the optimal timing for the relocation of the exit site, removal and reinsertion of the PD catheter, prognosis, and duration of antibiotic treatment remain unclear. This literature review aimed to investigate the epidemiology of patient characteristics and evaluate the most effective diagnostic and treatment strategies for PD catheter-related infections and peritonitis caused by NTM. The systematic literature review was conducted on published cases of PD catheter-related infection and peritonitis caused by NTM in PubMed, Embase, and Ichushi databases up to August 2022. A total of 335 cases (64.1%, male; mean age, 53.4 years; mean dialysis duration, 25.4 months) were analyzed. The most common causative agent of infection was Mycobacterium abscessus (40.1%), followed by Mycobacterium fortuitum (24.8%) and Mycobacterium chelonae (16.6%). With respect to diagnosis, 42.9%, 28.1%, and 29.0% of cases were diagnosed as PD catheter-related infection only, peritonitis only, and both, respectively. The initial cultures were positive for NTM only, positive for any other bacteria, and negative for NTM only in 56.5%, 19.8%, and 23.7% of cases, respectively. Ultimately, more than 80% of cases were treated with multiple antibiotics. PD catheter removal was performed in 55.4% of patients with PD catheter-related infections only and 85.5% of those with PD peritonitis. PD continuation or resumption was possible in 62.2% and 16.0% of patients, respectively. In conclusion, our findings indicate that it is advisable to perform acid-fast bacilli stain and culture in order to promptly identify NTM. PD catheter removal may be an essential management strategy during the early stages of NTM infection.
腹膜透析(PD)导管相关感染和非结核分枝杆菌(NTM)引起的腹膜炎的数量一直在增加。然而,对于出口部位的重新定位、PD 导管的移除和重新插入、预后以及抗生素治疗的持续时间,最佳时机仍不清楚。本文献综述旨在调查患者特征的流行病学,并评估治疗 NTM 引起的 PD 导管相关感染和腹膜炎的最有效诊断和治疗策略。系统文献综述在 PubMed、Embase 和 Ichushi 数据库中检索了截至 2022 年 8 月发表的与 NTM 引起的 PD 导管相关感染和腹膜炎相关的病例,并进行了文献综述。共分析了 335 例(64.1%,男性;平均年龄 53.4 岁;平均透析时间 25.4 个月)。感染的最常见病原体是脓肿分枝杆菌(40.1%),其次是偶然分枝杆菌(24.8%)和溃疡分枝杆菌(16.6%)。在诊断方面,分别有 42.9%、28.1%和 29.0%的病例仅被诊断为 PD 导管相关感染、腹膜炎和两者均有。最初的培养物中仅分枝杆菌阳性、其他任何细菌阳性和分枝杆菌阴性的比例分别为 56.5%、19.8%和 23.7%。最终,超过 80%的病例接受了多种抗生素治疗。在仅 PD 导管相关感染的患者中有 55.4%和在仅 PD 腹膜炎的患者中有 85.5%的患者进行了 PD 导管移除。PD 继续或恢复的可能性分别为 62.2%和 16.0%。总之,我们的研究结果表明,及时进行抗酸杆菌染色和培养以快速识别 NTM 是明智的。在 NTM 感染的早期阶段,PD 导管移除可能是一种重要的管理策略。