Temporary continuation of peritoneal dialysis after catheter replacement for Mycobacterium abscessus subsp. massiliense catheter-related infection in a pediatric patient

Abstract Background Peritoneal dialysis (PD) catheter-related infections can lead to catheter loss, peritonitis, and technique failure. Although nontuberculous mycobacteria are increasingly recognized as causative pathogens, optimal management of infections caused by the Mycobacterium abscessus complex (MABC) remains unclear, particularly when isolates are identified to the subspecies level. This report presents a pediatric PD catheter-related infection caused by M. abscessus subsp. massiliense , in which PD was temporarily continued after simultaneous catheter removal and replacement and prolonged multidrug therapy. Case presentation A 14-year-old girl with Sensenbrenner syndrome developed end-stage renal disease and was started on PD. At 8 months after initiation, she developed localized pain and purulent discharge at the catheter exit site. Initial cultures were negative; however, repeated cultures detected acid-fast bacilli, and MABC was identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Magnetic resonance imaging (MRI) showed a small abscess adjacent to the catheter. Intravenous imipenem/cilastatin, oral linezolid, and an oral macrolide were initiated. On hospital day 4, the catheter was completely removed and replaced through a separate contralateral tissue tract; PD was resumed 1 week later. Intraoperative findings revealed purulent drainage from the subcutaneous tunnel. Amikacin was added for persistent drainage but discontinued after audiometry demonstrated worsening hearing thresholds. Multiplex polymerase chain reaction (PCR) identified M. abscessus subsp. massiliense . The patient was discharged on hospital day 103. After 6 months, MABC was reisolated from the new exit site without abscess formation on MRI, and subsequent mycobacterial cultures were negative. Antimicrobial therapy was continued for approximately 30 months and discontinued at deceased-donor kidney transplantation and PD catheter removal. No clinical recurrence was observed during approximately 20 months of post-transplant immunosuppression. Conclusions Repeated cultures and rapid identification methods may be useful for persistent or initially culture-negative PD catheter-related infections. Subspecies-level identification may inform antimicrobial selection. In this patient with localized infection and no overt peritonitis, prompt catheter exchange and prolonged macrolide-containing multidrug therapy enabled temporary continuation of PD until kidney transplantation. However, microbiological eradication could not be established while the catheter remained in situ, and this strategy should not be generalized.