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1. Systematic literature review of the diagnosis, prognosis, and treatment of peritoneal dialysis-related infection caused by nontuberculous mycobacteria.

Author

Kadota N, Ishikawa K, Kubono Y, Konishi K, Fujimaru T, Ito Y, Nagahama M, Taki F, Kawai F, Mori N, and Nakayama M

Subjects
Humans, Prognosis, Mycobacterium chelonae isolation & purification, Mycobacterium abscessus isolation & purification, Mycobacterium fortuitum isolation & purification, Middle Aged, Male, Mycobacterium Infections, Nontuberculous diagnosis, Mycobacterium Infections, Nontuberculous therapy, Mycobacterium Infections, Nontuberculous epidemiology, Peritoneal Dialysis adverse effects, Catheter-Related Infections microbiology, Catheter-Related Infections diagnosis, Catheter-Related Infections therapy, Catheter-Related Infections epidemiology, Nontuberculous Mycobacteria isolation & purification, Peritonitis microbiology, Peritonitis diagnosis, Peritonitis etiology, Peritonitis epidemiology, Peritonitis drug therapy, Peritonitis therapy, Anti-Bacterial Agents therapeutic use
Abstract

The number of peritoneal dialysis (PD) catheter-related infections and peritonitis caused by nontuberculous mycobacteria (NTM) has been increasing. Nonetheless, the optimal timing for the relocation of the exit site, removal and reinsertion of the PD catheter, prognosis, and duration of antibiotic treatment remain unclear. This literature review aimed to investigate the epidemiology of patient characteristics and evaluate the most effective diagnostic and treatment strategies for PD catheter-related infections and peritonitis caused by NTM. The systematic literature review was conducted on published cases of PD catheter-related infection and peritonitis caused by NTM in PubMed, Embase, and Ichushi databases up to August 2022. A total of 335 cases (64.1%, male; mean age, 53.4 years; mean dialysis duration, 25.4 months) were analyzed. The most common causative agent of infection was Mycobacterium abscessus (40.1%), followed by Mycobacterium fortuitum (24.8%) and Mycobacterium chelonae (16.6%). With respect to diagnosis, 42.9%, 28.1%, and 29.0% of cases were diagnosed as PD catheter-related infection only, peritonitis only, and both, respectively. The initial cultures were positive for NTM only, positive for any other bacteria, and negative for NTM only in 56.5%, 19.8%, and 23.7% of cases, respectively. Ultimately, more than 80% of cases were treated with multiple antibiotics. PD catheter removal was performed in 55.4% of patients with PD catheter-related infections only and 85.5% of those with PD peritonitis. PD continuation or resumption was possible in 62.2% and 16.0% of patients, respectively. In conclusion, our findings indicate that it is advisable to perform acid-fast bacilli stain and culture in order to promptly identify NTM. PD catheter removal may be an essential management strategy during the early stages of NTM infection., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the local institutional ethical review board (Helsinki committee) of St. Luke’s International Hospital/University. The requirement for informed consent was waived by the ethical review board (Helsinki committee) of St. Luke’s International Hospital/University owing to the retrospective nature of this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Published
2024
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2. Development of acute kidney injury with massive granular casts and microscopic hematuria in patients with COVID-19: two case presentations with literature review.

Author

Fujimaru T, Shimada K, Hamada T, Watanabe K, Ito Y, Nagahama M, Taki F, Isokawa S, Hifumi T, Otani N, and Nakayama M

Abstract

Background: Complications of acute kidney injury (AKI) are common in patients with coronavirus disease in 2019 (COVID-19). However, clinical characteristics of COVID-19-associated AKI are poorly described. We present two cases of severe COVID-19 patients with AKI., Case Presentation: A 77-year-old woman was suspected of having vancomycin-associated AKI, and a 45-year-old man was suspected of having heme pigment-induced AKI caused by rhabdomyolysis. The granular cast, which is known to be a valuable diagnostic tool for confirming the diagnosis of acute tubular necrosis, was detected in both patients at the onset of AKI. Interestingly, both patients also developed microscopic hematuria at the occurrence of AKI, and one patient had elevated d-dimer and low platelet levels simultaneously., Conclusions: Some reports suggested that COVID-19-associated microangiopathy contributed to the kidney damage. Therefore, it is possible that our patients might have accompanied renal microangiopathy, and that this pathological background may have caused exaggerated tubular damage by vancomycin or heme pigment. The etiology of AKI in patients with COVID-19 is multifactorial. Superimposition of nephrotoxin(s) and virus-associate intra-renal microangiopathy may be a crucial trigger of kidney injury leading to severe AKI in COVID-19 patients. Therefore, in COVID-19 patients, risk factors for AKI should be taken into consideration to prevent its progression into severe AKI., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Published
2020
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