White R, Abreo K, Flanagan R, Gadallah M, Krane K, el-Shahawy M, Shakamuri S, McCoy R
Department of Medicine, Louisiana State University Medical Center, Shreveport 71130.
Am J Kidney Dis. 1993 Oct;22(4):581-7. doi: 10.1016/s0272-6386(12)80932-2.
Nontuberculous mycobacterial infections are a rare but clinically important cause of infections in continuous ambulatory peritoneal dialysis (CAPD) patients. We describe seven cases of catheter-related nontuberculous mycobacterial infections associated with CAPD. Six patients had Mycobacterium fortuitum infections and one had a Mycobacterium kansasii infection. Three patients presented with peritonitis, three presented with exit site infections, and one developed an infection at the exit site after catheter removal. There were no specific clinical findings that differentiated these infections from those caused by common bacterial pathogens. Initial routine peritoneal dialysis fluid and exit site cultures were negative in two patients and grew M fortuitum in four patients and M kansasii in one patient. M fortuitum and M kansasii were sensitive to amikacin, and M fortuitum was sensitive to ciprofloxacin when tested. Sensitivities to other antibiotics were variable. All patients were treated with a combination of antibiotics from 3 weeks to 6 months. Catheter removal was necessary for cure of the infection in all patients with peritonitis and in a majority of patients with exit site infections. The majority of patients changed to hemodialysis after catheter removal. Two patients remained on CAPD, with follow-up ranging from 2 months to 4 years. One patient has received a successful renal transplant. In conclusion, M fortuitum is the most common nontuberculous mycobacterial catheter-related infection in CAPD patients. Nontuberculous mycobacterial infections should be considered in the differential diagnosis of any culture-negative infection associated with CAPD. In patients with infections secondary to M fortuitum, our findings suggest that amikacin and ciprofloxacin are the initial antibiotics of choice until antibiotic sensitivities are available.
非结核分枝杆菌感染是持续性非卧床腹膜透析（CAPD）患者感染的罕见但临床重要原因。我们描述了7例与CAPD相关的导管相关性非结核分枝杆菌感染病例。6例患者为偶然分枝杆菌感染，1例为堪萨斯分枝杆菌感染。3例患者表现为腹膜炎，3例表现为出口处感染，1例在拔除导管后出口处发生感染。没有特异性临床发现可将这些感染与常见细菌病原体引起的感染区分开来。2例患者的初始常规腹膜透析液和出口处培养结果为阴性，4例患者培养出偶然分枝杆菌，1例患者培养出堪萨斯分枝杆菌。偶然分枝杆菌和堪萨斯分枝杆菌对阿米卡星敏感，检测时偶然分枝杆菌对环丙沙星敏感。对其他抗生素的敏感性各不相同。所有患者均接受了3周至6个月的联合抗生素治疗。所有腹膜炎患者和大多数出口处感染患者为治愈感染均需拔除导管。大多数患者在拔除导管后改为血液透析。2例患者继续进行CAPD，随访时间为2个月至4年。1例患者成功接受了肾移植。总之，偶然分枝杆菌是CAPD患者中最常见的非结核分枝杆菌导管相关性感染。在与CAPD相关的任何培养阴性感染的鉴别诊断中均应考虑非结核分枝杆菌感染。对于偶然分枝杆菌继发感染的患者，我们的研究结果表明，在获得抗生素敏感性结果之前，阿米卡星和环丙沙星是初始首选抗生素。
