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Infection with antimicrobial-resistant microorganisms in dialysis patients
1Department of Medicine, Renal, Electrolyte, and Hypertension Division, University of Pennsylvania School of Medicine and Presbyterian Medical Center, Philadelphia, Pennsylvania 19104, USA. bernsj@uphs.upenn.edu
Abstract:
The prevalence of antimicrobial-resistant microorganisms in various health care settings, including outpatient dialysis facilities, has increased dramatically in the last decade. Antimicrobial use and patient-to-patient transmission of resistant strains are the two main factors that have contributed to this rapid increase. Methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci are commonly isolated as a cause of hemodialysis (HD) catheter-related bacteremia and peritoneal dialysis (PD)-related catheter infection and peritonitis. The widespread use of vancomycin in dialysis patients is of concern because of an increase in the prevalence of vancomycin-resistant enterococci (VRE) in dialysis patients. Staphylococci with reduced sensitivity to vancomycin have also appeared in dialysis patients. A more recent problem is the appearance of S. aureus isolates with a high degree of resistance to the topical antimicrobial agent mupirocin. This has been seen in PD patients who have received prophylactic application of mupirocin at the peritoneal catheter exit site. Appropriate antimicrobial use will help protect the efficacy of currently used antibiotics, such as vancomycin. Published guidelines for use of vancomycin should be followed. New antimicrobials such as linezolid and quinupristin/dalfopristin have activity against VRE and MRSA, but resistance to these agents has already occurred. Preventing transmission of antimicrobial-resistant microorganisms in health care settings, including outpatient dialysis facilities, is important in limiting the spread of these resistant organisms.
Insights
Antimicrobial resistance is rising in dialysis patients due to increased antimicrobial use and transmission. This includes methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), necessitating careful antibiotic management.
Area of Science:
- Infectious Diseases
- Nephrology
- Microbiology
Background:
- Increasing prevalence of antimicrobial-resistant microorganisms in healthcare settings, particularly outpatient dialysis facilities.
- Antimicrobial use and patient-to-patient transmission are key drivers of this rise.
- Commonly isolated resistant organisms include MRSA and VRE, causing significant infections in hemodialysis (HD) and peritoneal dialysis (PD) patients.
Purpose of the Study:
- To highlight the growing problem of antimicrobial resistance in dialysis patients.
- To discuss the impact of antimicrobial use on the emergence of resistance, including vancomycin and mupirocin resistance.
- To emphasize the importance of infection control and appropriate antimicrobial stewardship.
Main Methods:
- Review of current literature and clinical observations regarding antimicrobial resistance patterns in dialysis populations.
- Identification of common resistant pathogens and associated infections (e.g., catheter-related bacteremia, peritonitis).
- Analysis of factors contributing to resistance, such as prophylactic and therapeutic antimicrobial use.
Main Results:
- Significant increase in MRSA and VRE in HD and PD patients.
- Emergence of vancomycin-resistant staphylococci and high-level mupirocin resistance in S. aureus, especially in PD patients using prophylactic mupirocin.
- Newer agents like linezolid and quinupristin/dalfopristin show activity but already face emerging resistance.
Conclusions:
- Appropriate antimicrobial use, including adherence to vancomycin guidelines, is crucial for preserving antibiotic efficacy.
- Preventing transmission of resistant organisms in dialysis facilities is essential.
- Ongoing surveillance and development of new strategies are needed to combat antimicrobial resistance in this vulnerable patient group.