Species-specific outcomes and role of infectious disease consultation in peritoneal dialysis infections caused by nontuberculous mycobacteria: A 10-year retrospective analysis

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Abstract
Background: Infections can make it difficult to continue peritoneal dialysis (PD). Nontuberculous mycobacteria-associated PD (NTM-PD) infections, while rare, frequently pose a treatment challenge due to their intractable nature and the lack of established therapeutic guidelines. As a result, we aimed to investigate the clinical characteristics of NTM infections in patients undergoing PD. Methods: We retrospectively examined consecutive patients with NTM-PD infections from 2012 to 2022. The cases were identified through microbiological records. The primary outcomes were all-cause mortality and transition to hemodialysis. Secondary outcomes included treatment duration and antimicrobial regimens. Outcomes were compared across different NTM species and between cases with and without infectious disease (ID) consultation. Results: Among 177 patients undergoing PD, we identified 22 NTM infections in 20 patients. The predominant species were M. chelonae (36%), M. fortuitum (36%), and M. abscessus (23%). Twelve patients were transitioned to hemodialysis, with no mortality. All M. abscessus infections ( n =  5) required transition to hemodialysis, compared to 46% in other species. ID consultation ( n =  15) was linked to more frequent antimicrobial susceptibility testing (60% vs. 0%, p <  .05), longer treatment duration (5.7 vs. 1.2 months, p <  .05), and increased use of combination therapies (100% vs. 43%, p <  .05). However, ID consultation did not affect the frequency of transition to hemodialysis. Conclusion: Early identification of NTM species and timely ID consultation can help optimize management strategies for these challenging infections.

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