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Vancomycin-resistant enterococcus in end-stage renal disease

J P Brady1, J W Snyder, J A Hasbargen

  • 1Nephrology Specialists, PC, Munster, IN 46321, USA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 18, 1998
PubMed
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Vancomycin-resistant enterococci (VRE) are a growing concern. This study found a low incidence of VRE in dialysis patients, suggesting continued judicious vancomycin use and surveillance are warranted.

Area of Science:

  • Infectious Diseases
  • Nephrology
  • Clinical Microbiology

Background:

  • Rising rates of nosocomial vancomycin-resistant enterococci (VRE) in the US.
  • Recommendations to reserve vancomycin for resistant infections.
  • Need to assess VRE incidence in renal patients.

Purpose of the Study:

  • To prospectively investigate VRE incidence in dialysis patients.
  • To compare VRE rates with a control group of chronic renal insufficiency (CRI) patients.
  • To analyze antimicrobial exposure in relation to VRE colonization.

Main Methods:

  • Prospective study of 50 hemodialysis (HD), 50 peritoneal dialysis (PD), and 40 CRI patients.
  • Rectal swab cultures for enterococci (VSE and VRE).
  • Review of antimicrobial use in the 6 months prior to swabbing.

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Main Results:

  • VRE isolated in 2% of PD patients; none in CRI or HD patients.
  • Vancomycin use was 32% in HD and 36% in PD patients.
  • Despite antimicrobial use, VRE incidence was low (<2%) in the renal population.

Conclusions:

  • The incidence of VRE in this renal population is lower than reported US data.
  • Judicious vancomycin use is recommended for renal patients.
  • Continued surveillance for enterococcal sensitivity is advised.