NONTUBERCULOUS MYCOBACTERIAL INFECTIONS IN CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS PATIENTS

被引:44
作者
WHITE, R
ABREO, K
FLANAGAN, R
GADALLAH, M
KRANE, K
ELSHAHAWY, M
SHAKAMURI, S
MCCOY, R
机构
[1] VET ADM MED CTR,SHREVEPORT,LA
[2] SCHUMPERT MED CTR,SHREVEPORT,LA
[3] TULANE UNIV,MED CTR,DEPT MED,NEW ORLEANS,LA 70118
[4] UNIV SO CALIF,MED CTR,DEPT MED,LOS ANGELES,CA 90089
[5] GOOD SHEPHERD MED CTR,DEPT MED,LONGVIEW,TX
关键词
NONTUBERCULOUS MYCOBACTERIA; MYCOBACTERIUM FORTUITUM; MYCOBACTERIUM-KANSASII; PERITONITIS; PERITONEAL DIALYSIS;
D O I
10.1016/S0272-6386(12)80932-2
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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. © 1993, National Kidney Foundation. All rights reserved. All rights reserved.
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页码:581 / 587
页数:7
相关论文
共 24 条
[1]   NONTUBERCULOUS MYCOBACTERIAL PERITONITIS DURING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS - CASE-REPORT AND REVIEW OF DIAGNOSTIC AND THERAPEUTIC STRATEGIES [J].
DUNMIRE, RB ;
BREYER, JA .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1991, 18 (01) :126-130
[2]  
FENTON S, 1981, PERITON DIALYSIS B, V1, pS4
[3]   PERITONITIS CAUSED BY MYCOBACTERIUM-KANSASII IN A PATIENT UNDERGOING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS [J].
GILADI, M ;
LEE, BE ;
BERLIN, OGW ;
PANOSIAN, CB .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1992, 19 (06) :597-599
[4]  
LAROCCO MT, 1986, DIAGN MICR INFEC DIS, V4, P161, DOI 10.1016/0732-8893(86)90151-3
[5]   MYCOBACTERIUM-GASTRI PERITONITIS IN A PATIENT UNDERGOING CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS [J].
LINTON, IM ;
LEAHY, SI ;
THOMAS, GW .
AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 1986, 16 (02) :224-225
[6]  
LONDON RD, 1988, AM J MED, V85, P703
[7]   MYCOBACTERIUM CHELONAE PERITONITIS ASSOCIATED WITH CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS [J].
MERLIN, TL ;
TZAMALOUKAS, AH .
AMERICAN JOURNAL OF CLINICAL PATHOLOGY, 1989, 91 (06) :717-720
[8]  
NOLPH KD, 1991, KIDNEY, P2299
[9]  
PETER G, 1988, REPORT COMMITTEE INF, P447
[10]  
PETERSON PK, 1987, REV INFECT DIS, V9, P604