WCN26-6844 LEARNING FROM LEAKS: INSIGHTS FROM A CASE SERIES ON PD LEAKS

Introduction: Non-tuberculous mycobacteria (NTM) infections in peritoneal dialysis (PD) patients are generally rare but occur more commonly in warmer climates in tropical Asian countries and cause significant morbidity.There are no clear guidelines on management to date, with most case series reporting poor outcomes with conservative management, the need for catheter removal, and prolonged antimicrobial therapy to control the infection. Methods:Results: A 46-year-old Chinese lady who had a history of hypertension, hyperlipidemia, and primary hypothyroidism developed kidney failure from likely secondary focal segmental glomerular sclerosis and was initiated on peritoneal dialysis in 2018.She had refractory staphylococcal exit site infections involving the external cuff in 2022, requiring multiple courses of antibiotics.Her PD catheter was exteriorized in May 2022 and subsequently removed in Jan 2023, followed by reinsertion on the contralateral right side in Feb 2023.She later developed Mycobacterium abscessus catheter exit site infection in Aug 2024, and the catheter was promptly removed within 3 days of obtaining culture result, and she was converted to hemodialysis.For this catheter removal, a right paramedian incision was made intraoperatively.She was treated with cefoxitin, amikacin and azithromycin induction therapy for 3 weeks and subsequently maintained on azithromycin and clofazimine, which were later stopped in mid Sep 2024 as she developed liver impairment and had good clinical improvement with no discharge noted from the old right exit site and right paramedian incision wounds.In end Sep 2024, one week after cessation of NTM treatment, the right incision wound from the recent catheter removal surgery was noted to have haemoserous discharge, which resolved quickly within a week with antibiotics.The old exit site remained clean, and she was subsequently keen to return to PD. PD catheter was reinserted on the contralateral (left) side in Nov 2024.Nine days after this new left PD catheter insertion, there was recurrence of discharge from the same previously discharging right incision wound, which also grew Mycobacterium abscessus.A computer tomography (CT) scan in Dec 2024 showed a small rim enhancing fluid collection around this right incision wound, but no feature suggestive of infection at the new left PD catheter site.She was treated with 1 month of induction combination therapy followed by six months of maintenance therapy till May 2025.She remained on HD initially and returned to PD in April 2025.Conclusion: This case highlights the need for a prolonged course of maintenance antibiotic therapy to effectively treat Mycobacterium abscessus catheter-related infection, as inadequate treatment duration may lead to recurrence.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.