1626. Non-Tuberculous Mycobacterial Infections in Peritoneal Dialysis Patients in the United States
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • colombo IDSA poster NTM FINAL 092513.pdf (506.9 kB)
  • Background: Non-tuberculous mycobacteria (NTM) are common environmental organisms and potential human pathogens. NTM peritonitis is a complication of peritoneal dialysis (PD); the incidence of this and other forms of NTM infection among PD patients in the United States (US) has not been established. We recently described NTM infections among end stage renal disease (ESRD) patients on hemodialysis (HD) in the US (Colombo et al, J Invest Med, 61:507, 2013). To extend those observations, the present study assessed NTM infection in US PD patients.

    Methods: All ESRD cases in the United States Renal Data System (USRDS) from 1998-2008 were queried for a diagnosis of NTM infection and potential clinical covariates using ICD-9 diagnosis codes. Initial dialysis access type was used to categorize individuals as PD or HD. Classification of NTM disease was achieved via querying codes for pulmonary (PULM), disseminated (DISS), cutaneous (CUT), and “other” (OTH) NTM. Demographics, geographic distribution, and human immunodeficiency virus (HIV) status were also examined.

    Results: 1748 ESRD patients were diagnosed with NTM infection during the 11-year period of study. In 161 (9.2%) of these patients, PD was the initial form of dialysis. Demographics included: 65% aged ≥ 50 years, 51% male, 22% African American (AA), and 87% HIV negative (-). Among PD patients, OTH infection (56%) was most common, followed by PULM (26%), DISS (14%), and CUT (3%); HD patients were more likely to have PULM (40%; p<0.001) or DISS (32%; p<0.0001) infection. Residents of the Southern US were disproportionately affected (total NTM: 46% PD, 52% HD), irrespective of infection type or HIV status.

    PD patients with NTM were less likely than those on HD to have HIV (p<0.0001), yet demographics of HIV positive (+) patients were similar: age ≤ 50 years (PD 86%; HD 84%), male (PD 81%; HD 73%), and AA (PD 81%; HD 89%). DISS was the most common NTM disease in HIV (+) patients regardless of form of dialysis. Among HIV (-) patients, PD was significantly associated with OTH (62%; p<0.0001) and HD with PULM (44%, p<0.0001) NTM.

    Conclusion: Approximately 9% of cases of NTM infection diagnosed in US ESRD patients occurred among those who initiated dialysis on PD. OTH infection, which would include NTM peritonitis, was the most common NTM type in PD patients.  The majority of PD patients diagnosed with NTM were HIV (-).

    Rhonda Colombo, MD1, Puja Chebrolu1, Stephanie Baer, MD2, Mufaddal Kheda, MD1, N Stanley Nahman Jr., MD1,2 and Kristina Kintziger, PhD, MPH1, (1)Georgia Regents University, Augusta, GA, (2)Charlie Norwood Vet., Augusta, GA

    Disclosures:

    R. Colombo, None

    P. Chebrolu, None

    S. Baer, None

    M. Kheda, None

    N. S. Nahman Jr., None

    K. Kintziger, None

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