# Nontuberculous Mycobacterium Peritonitis in Patients on Peritoneal Dialysis: A Scoping Review

## TL;DR

This review summarizes the challenges and outcomes of diagnosing and treating nontuberculous mycobacterial peritonitis in peritoneal dialysis patients.

## Contribution

The study provides a comprehensive overview of clinical features, treatment strategies, and outcomes for NTM peritonitis in PD patients.

## Key findings

- Rapid-growing Mycobacterium fortuitum is the most common NTM causing peritonitis in PD patients.
- Delayed treatment and high mortality rates are common in NTM peritonitis cases.
- Catheter removal and prolonged antimicrobial therapy are often required for management.

## Abstract

Early and accurate identification of causative microorganisms is essential for improving outcomes in peritoneal dialysis (PD)-associated peritonitis. However, nontuberculous mycobacterial (NTM) peritonitis remains difficult to diagnose and manage, often resulting in delayed treatment and unfavorable clinical outcomes. We conducted a scoping review to summarize the clinical features, microbiological profiles, treatment strategies, and outcomes of PD-associated NTM peritonitis. A total of 107 patients from 81 published reports were identified, including one patient treated at our institution. The mean age was 50.1 years, with a slight male predominance. Diabetes mellitus was the most common underlying cause of end-stage renal disease. Abdominal pain, fever, and cloudy dialysate were the most frequently reported symptoms, and exit-site infection was present in 55% of cases. Rapid-growing NTM species predominated, with Mycobacterium fortuitum being the most frequently identified organism. A substantial delay was observed between symptom onset and initiation of appropriate therapy. The mean duration of antimicrobial treatment was six months. PD catheters were removed in 90% of patients, and 69% were permanently transitioned to hemodialysis. The overall mortality rate during treatment was 18%. These findings suggest that NTM infection should be considered in cases of culture-negative peritonitis unresponsive to standard antibiotics. Early catheter removal combined with prolonged multidrug antimicrobial therapy for at least six months may be beneficial. In pediatric patients, temporary conversion to hemodialysis followed by PD catheter reinsertion or renal transplantation may represent a reasonable management option after successful infection control.