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Antimicrobial-resistant, Gram-positive bacteria among patients undergoing chronic hemodialysis
1Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA. edagata@caregroup.harvard.edu
Abstract:
Numerous antimicrobial-resistant pathogens (ARPs) have emerged among patients who undergo chronic hemodialysis (CHD), including vancomycin-resistant enterococci, vancomycin-resistant coagulase-negative staphylococci, Staphylococcus aureus with reduced susceptibility to vancomycin, and linezolid-resistant S. aureus. In June 2002, the first isolate of vancomycin-resistant S. aureus (minimum inhibitory concentration of vancomycin, > or =32 microg/mL) was isolated in the United States from a patient who required CHD. Frequent administration of antibiotics and repeated exposure to settings conducive to cross-transmission contribute to a patient population at considerable risk of harboring ARPs. Dissemination of ARPs among patients who are undergoing CHD is facilitated by the requirement for regular hemodialysis in a closed setting in which health care workers provide concurrent care to multiple patients. Frequent hospitalizations in this patient population further contribute to acquisition of ARPs and to the spread of ARPs to other hospitalized patients. The epidemiology of antimicrobial-resistant, gram-positive pathogens in patients undergoing CHD is reviewed, and recommendations for limiting further dissemination are provided.
Insights
Patients undergoing chronic hemodialysis (CHD) face high risks of acquiring antimicrobial-resistant pathogens (ARPs). This review covers resistant gram-positive pathogens in CHD patients and offers strategies to limit their spread.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Patients undergoing chronic hemodialysis (CHD) are at increased risk for antimicrobial-resistant pathogens (ARPs).
- Emergence of resistant strains like vancomycin-resistant enterococci and Staphylococcus aureus is a growing concern in this population.
- Frequent antibiotic use and healthcare settings facilitate ARP acquisition and transmission.
Purpose of the Study:
- To review the epidemiology of antimicrobial-resistant, gram-positive pathogens in patients undergoing CHD.
- To provide recommendations for limiting the dissemination of ARPs in this vulnerable patient group.
Main Methods:
- Literature review focusing on antimicrobial resistance in chronic hemodialysis patients.
- Analysis of pathogen prevalence, risk factors, and transmission dynamics.
- Synthesis of current recommendations for infection control.
Main Results:
- Identified key ARPs including vancomycin-resistant enterococci and resistant Staphylococcus aureus strains.
- Highlighted frequent hospitalizations and the hemodialysis setting as critical factors for ARP spread.
- Documented the first US isolate of vancomycin-resistant Staphylococcus aureus in a CHD patient in June 2002.
Conclusions:
- Antimicrobial resistance poses a significant threat to patients on chronic hemodialysis.
- Implementing targeted infection control strategies is crucial to mitigate ARP dissemination.
- Further research and vigilance are needed to manage resistant pathogens in this population.