Mycobacterium Tuberculosis Peritonitis in Peritoneal Dialysis Patients: A Scoping Review

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Thomson, Benjamin
Vaughan, Stephen
Momciu, Bogdan
Peritoneal Dialysis , Mycobacterium Tuberculosis , Peritonitis , Multi-drug Resistant Tuberculosis , High Burden Tuberculosis Country
Background: The clinical syndrome of Mycobacterium tuberculosis (TB) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local TB patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown. Methods: A scoping review identified published cases of TB PD peritonitis. Cases from low and high TB burden areas were compared, and cases that did or did not suffer a poor clinical outcome were compared. Results: There were 216 cases identified. Demographics, presentation, diagnosis, treatment and outcomes were described. Significant delays in diagnosis were common (6.1 weeks) and were longer in patients from low TB burden regions (7.3 vs 3.7 weeks). In low TB burden areas, slower diagnostic methods were more commonly used like PD fluid culture (64.3 vs. 32.7%), and treatment was less likely with quinolone antibiotics (6.9 vs 34.1%). Higher national TB incidence and lower GDP per capita were found in cases that suffered PD catheter removal or death. Diagnostic delays were not longer in cases in which a patient suffered PD catheter removal or death. Cases that suffered death were older (51.9 vs 45.1 years) and less likely female (37.8 vs. 55.7%). Removal of PD catheter was more common in cases in which a patient died (62.0 vs 49.1%). Conclusions: Outcomes in TB PD peritonitis are best predicted by national TB incidence, patient age and sex. Several unique features are identified to alert clinicians to use more rapid diagnostic methods that might enhance outcomes in TB PD peritonitis.