Development of multidrug-resistant Mycobacterium tuberculosis in the biofilm of a peritoneal-venous shunt

Romany M Redman; Timothy D Maughan; Charles B Smith; Peter F Crossno; Donald L Granger

doi:10.1016/j.idcr.2023.e01801

Development of multidrug-resistant Mycobacterium tuberculosis in the biofilm of a peritoneal-venous shunt

IDCases. 2023 May 18:32:e01801. doi: 10.1016/j.idcr.2023.e01801. eCollection 2023.

Authors

Romany M Redman¹, Timothy D Maughan², Charles B Smith^{3

4}, Peter F Crossno⁵, Donald L Granger³

Affiliations

¹ Department of Internal Medicine, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84145, USA.
² Infectious Diseases Clinic, Providence Sacred Heart Hospital, 101 West 8th Avenue, Spokane, WA 99204, USA.
³ Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA.
⁴ Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84145, USA.
⁵ Division of Pulmonary Medicine, Department of Medicine, Intermountain Healthcare, 5121 Cottonwood Street, Murray, UT 84107, USA.

Abstract

A patient with ascites received a peritoneal-venous shunt for presumed cirrhosis, however surgical specimens grew Mycobacterium tuberculosis (MTb) sensitive to all anti-tuberculous drugs. Directly-Observed-Therapy (DOT) led to improvement followed by relapse with multidrug resistant MTb (MDRTB). We discuss pathways for selection of MDRTB within mycobacterial biofilm. This case illustrates the potential for development of MDRTB in patients with long-term indwelling catheters. We emphasize catheter removal and if not possible continuing follow-up for symptoms and signs of relapse.

Keywords: Biofilm; Denver catheter; Foreign body; Multi-drug resistance; Relapse; Tuberculosis.

Publication types

Case Reports