# Refractory Tunnel Infections Caused by Multidrug-Resistant Mycobacterium abscessus Requiring Peritoneal Dialysis Catheter Removal

## TL;DR

A patient with a multidrug-resistant Mycobacterium abscessus tunnel infection required PD catheter removal after failing antibiotic treatment.

## Contribution

The case highlights the importance of prompt catheter removal for M. abscessus tunnel infections when antimicrobial therapy fails.

## Key findings

- Multidrug-resistant M. abscessus tunnel infection did not respond to antimicrobial therapy.
- Catheter removal two days after resistance confirmation led to successful treatment.
- Current guidelines lack clear strategies for treating M. abscessus tunnel infections.

## Abstract

Tunnel infections (TI) remain a challenging peritoneal dialysis (PD) complication, particularly when caused by Mycobacterium abscessus (M. abscessus). M. abscessus often exhibits multidrug resistance and frequently causes PD catheter removal. We report a case of TI due to multidrug-resistant M. abscessus that failed to respond to antimicrobial therapy and required catheter removal. A 58‑year‑old man on PD for end‑stage renal disease (ESRD) presented with localized abdominal tenderness and erythema with purulent discharge along the PD catheter tunnel tract. Levofloxacin (LVFX) was initiated empirically. M. abscessus was isolated on day 4, and susceptibility testing on day 12 revealed multidrug resistance to antimicrobial therapy, including antituberculosis agents. Despite continued antimicrobial therapy, the infection persisted, and the catheter was removed on day 14. The patient subsequently transitioned to hemodialysis and recovered uneventfully. An optimal therapeutic strategy for TI has not yet been clearly established in current clinical guidelines. In this case, the removal of the PD catheter two days after confirmation of multidrug resistance likely contributed to treatment success. In case of M. abscessus-related TI, prompt catheter removal should be considered as one of the treatment options.