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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Peritoneal dialysis (PD) is an established renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD), but infectious complications remain a major limitation to its long-term success. Catheter-related infections, including exit-site infections (ESI) and tunnel infections (TI), can necessitate catheter removal and may lead to refractory peritonitis. Non-tuberculous mycobacteria (NTM), particularly Mycobacterium abscessus (M. abscessus), have increasingly been recognized as causative pathogens. These organisms often exhibit intrinsic multidrug resistance to antimicrobial therapies, making treatment challenging. Despite their clinical relevance, the 2023 revision of the International Society for Peritoneal Dialysis (ISPD) guidelines does not provide a standardized therapeutic strategy for TI. We report a case of TI caused by multidrug-resistant M. abscessus requiring PD catheter removal.
A 58-year-old man with ESRD due to diabetic kidney disease (DKD), complicated by hypertension, chronic kidney disease–mineral and bone disorder (CKD-MBD), and renal anemia, presented with localized abdominal tenderness and purulent discharge from the tunnel tract of the PD catheter. PD had been initiated in two years ago, but combined therapy with hemodialysis was introduced for inadequate fluid control in one year ago. Physical examination showed erythema and pus expression at the tunnel fistula, while laboratory findings demonstrated no systemic inflammatory response.
TI was diagnosed, and levofloxacin (LVFX) was initiated empirically. On day 4 of illness, M. abscessus was isolated from a culture specimen. Despite continuation of LVFX, purulent discharge persisted. On day 12, susceptibility testing revealed multidrug resistance to antimicrobial therapies, including resistance to anti-tuberculosis drugs. Conservative antimicrobial management was deemed ineffective. The patient was hospitalized on day 13, and surgical catheter removal was performed on day 14. He transitioned to thrice-weekly hemodialysis on day 18 and was discharged in stable condition on day 25.
Antibiotics
MIC(μg/mL)
Interpretation
Rifampicin(RFP)
>32
R
Streptomycin(SM)
128
Kanamycin(KM)
32
Ethambutol(EB)
64
Levofloxacin(LVFX)
Amikacin(AMK)
>16
This case illustrates the therapeutic challenges of M. abscessus-related TI in PD. Multidrug resistance limits the effectiveness of antimicrobial therapy, and timely catheter removal often becomes the cornerstone of treatment. While there are rare reports of successful continuation of PD without catheter removal, the majority of cases, including ours, require removal for resolution. In line with the 2007 American Thoracic Society (ATS)/ Infectious Diseases Society of America (IDSA) statement emphasizing the necessity of foreign body removal, this case reinforces the importance of individualized treatment strategies that integrate pathogen susceptibility profiles with patient-specific clinical factors. Further research and consensus are needed to establish optimal management approaches for NTM-related catheter infections in PD.
