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The emergence of vancomycin resistance in renal dialysis
D Sanyal1, A J Williams, A P Johnson
1Public Health Laboratory, Northern General Hospital, Sheffield.
Abstract:
Intraperitoneal vancomycin is used in the treatment of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We describe the emergence of low-level glycopeptide-resistance in five Gram-positive species over a one-year period. Isolation of these organisms was associated with vancomycin treatment failure in four patients who had had numerous episodes of peritonitis. Clinicians and microbiologists should be aware that repeated administration of glycopeptides to such patients might lead to the emergence of organisms resistant to these antibiotics.
Insights
Repeated vancomycin treatment for peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients can lead to emerging glycopeptide-resistant Gram-positive bacteria, causing treatment failure.
Area of Science:
- Microbiology
- Infectious Diseases
- Nephrology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) patients frequently experience peritonitis, often treated with intraperitoneal vancomycin.
- Vancomycin, a glycopeptide antibiotic, is a cornerstone in managing Gram-positive bacterial peritonitis in CAPD.
Observation:
- Over one year, five Gram-positive bacterial species demonstrated emerging low-level glycopeptide resistance.
- This resistance emerged in patients with a history of recurrent peritonitis episodes.
Findings:
- The isolation of resistant organisms coincided with vancomycin treatment failure in four patients.
- Treatment failure occurred despite continued vancomycin administration.
Implications:
- Repeated glycopeptide use in CAPD patients with peritonitis poses a risk for selecting resistant bacteria.
- Clinicians and microbiologists must monitor for and be aware of emerging glycopeptide resistance.
- Alternative or combination antibiotic strategies may be necessary for peritonitis in patients with prior vancomycin exposure.