Ishikawa Kazuhiro, Kadota Nozomi, Nakayama Masaaki, Mori Nobuyoshi
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan.
IJID Reg. 2025 May 7;15:100659. doi: 10.1016/j.ijregi.2025.100659. eCollection 2025 Jun.
Non-tuberculous mycobacteria can result in peritoneal dialysis (PD)-associated peritonitis and PD catheter-related infections, including tunnel and exit site infection. We report the case of a 78-year-old male patient undergoing PD for end-stage renal failure due to diabetic nephropathy, with a medical history that includes PD catheter-related infections. He developed peritonitis secondary to a PD catheter-related infection. grew on blood agar, and its identification was confirmed using matrix-assisted laser desorption ionization-time of flight/mass spectrometer (MALDI-TOF/MS) and 16S rRNA sequencing. Based on susceptibility testing, treatment was initiated with trimethoprim/sulfamethoxazole (TMP/SMX) (80 mg/400 mg) 5 mg/kg every 24 hours in combination with minocycline 100 mg every 12 hours, which was subsequently changed to TMP/SMX plus faropenem 200 mg every 8 hours due to nausea caused by minocycline. However, the antimicrobial therapy proved to be ineffective, and the patient subsequently developed complicated PD-associated peritonitis, leading to the removal of the PD catheter. We switched to TMP/SMX, imipenem/cilastatin 500 mg every 12 hours, and used linezolid 600 mg every 12 hours, which was later replaced with amikacin, guided by therapeutic drug monitoring. Subsequent complications related to antimicrobial therapy included nausea caused by linezolid and hearing impairment due to amikacin. We treated the patient with TMP/SMX and sitafloxacin 100 mg every 24 hours, which was well-tolerated. The patient was treated for 18 months without a relapse. Our findings underscore the importance of suspecting non-tuberculous mycobacteria in PD catheter-related infection and considering the early inclusion of acid-fast bacillus culture. Given the diagnostic challenges and the complexity of managing multi-drug antimicrobial therapy in patients with renal dysfunction, we recommend early catheter removal.
非结核分枝杆菌可导致腹膜透析（PD）相关腹膜炎及PD导管相关感染，包括隧道感染和出口处感染。我们报告了一例78岁男性患者，因糖尿病肾病导致终末期肾衰竭而接受PD治疗，其病史包括PD导管相关感染。他继发于PD导管相关感染而发生腹膜炎。该菌在血琼脂平板上生长，通过基质辅助激光解吸电离飞行时间质谱仪（MALDI-TOF/MS）和16S rRNA测序确认了其鉴定结果。根据药敏试验，开始使用甲氧苄啶/磺胺甲恶唑（TMP/SMX）（80mg/400mg）每24小时5mg/kg联合米诺环素100mg每12小时进行治疗，随后因米诺环素引起的恶心而改为TMP/SMX加法罗培南200mg每8小时。然而，抗菌治疗被证明无效，患者随后发生了复杂的PD相关腹膜炎，导致PD导管被拔除。我们改用TMP/SMX、亚胺培南/西司他丁每12小时500mg，并使用利奈唑胺每12小时600mg，后来在治疗药物监测的指导下换用阿米卡星。随后与抗菌治疗相关的并发症包括利奈唑胺引起的恶心和阿米卡星导致的听力损害。我们用TMP/SMX和司他夫沙星每24小时100mg治疗该患者，患者耐受性良好。该患者接受了18个月的治疗且未复发。我们的研究结果强调了在PD导管相关感染中怀疑非结核分枝杆菌并考虑早期进行抗酸杆菌培养的重要性。鉴于诊断挑战以及肾功能不全患者多药抗菌治疗管理的复杂性，我们建议早期拔除导管。
