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Conference Paper: Evolution of antibiotic resistance mechanisms and their relevance to dialysis-related infections
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TitleEvolution of antibiotic resistance mechanisms and their relevance to dialysis-related infections
 
AuthorsWong, SSY1
Ho, PL1
Yuen, KY1
 
Issue Date2007
 
PublisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
 
CitationPeritoneal Dialysis International, 2007, v. 27 SUPPL. 2, p. S272-S280 [How to Cite?]
 
AbstractAs the survival of patients with end-stage renal failure has improved, their exposure to antibiotics has also increased. Infections, especially peritoneal dialysis-related peritonitis, are unavoidable because of lapses in technique and the stow worsening of systemic and peritoneal defense associated with aging and dialysis. The selective pressure inherent in the use of antibiotics shapes the pattern of antibiotic resistance in the bacteria causing peritonitis and extraperitoneal infections, and vice versa. Renal function-preserving and non-ototoxic regimens that incorporate double β-lactams (first- and third-generation cephalosporins) for peritonitis have increased the selective pressure in favor of methicillin-resistant staphylococci (HRS) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Attempts to use the fluoroquinolones as alternatives to β-lactams was met with rocketing quinolone resistance. The high incidence of MRS led many nephrologists to use empiric vancomycin - until the début of vancomycin-resistant enterococci. The recent emergence of heterogeneous and high-level vancomycin resistance in staphylococci (which are especially prevalent in patients on dialysis) calls for further prudence in the use of vancomycin. The coming challenges are ESBL-producing Enterobacteriaceae with carbapenemase, multi-resistant Pseudomonas, and highly virulent community-acquired methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin. Antibiotic auditing programs and meticulous patient training by nurses are the only available defense at the moment. Novel approaches such as antibiotic-impregnated Tenckhoff catheters, biocompatible dialysis fluid, and peritoneal immuno-augmentation strategies are eagerly awaited. Copyright © 2007 International Society for Peritoneal Dialysis. Printed in Canada. All rights reserved.
 
ISSN0896-8608
2012 Impact Factor: 2.214
2012 SCImago Journal Rankings: 0.773
 
ISI Accession Number IDWOS:000257889500048
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorWong, SSY
 
dc.contributor.authorHo, PL
 
dc.contributor.authorYuen, KY
 
dc.date.accessioned2012-08-08T09:06:08Z
 
dc.date.available2012-08-08T09:06:08Z
 
dc.date.issued2007
 
dc.description.abstractAs the survival of patients with end-stage renal failure has improved, their exposure to antibiotics has also increased. Infections, especially peritoneal dialysis-related peritonitis, are unavoidable because of lapses in technique and the stow worsening of systemic and peritoneal defense associated with aging and dialysis. The selective pressure inherent in the use of antibiotics shapes the pattern of antibiotic resistance in the bacteria causing peritonitis and extraperitoneal infections, and vice versa. Renal function-preserving and non-ototoxic regimens that incorporate double β-lactams (first- and third-generation cephalosporins) for peritonitis have increased the selective pressure in favor of methicillin-resistant staphylococci (HRS) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Attempts to use the fluoroquinolones as alternatives to β-lactams was met with rocketing quinolone resistance. The high incidence of MRS led many nephrologists to use empiric vancomycin - until the début of vancomycin-resistant enterococci. The recent emergence of heterogeneous and high-level vancomycin resistance in staphylococci (which are especially prevalent in patients on dialysis) calls for further prudence in the use of vancomycin. The coming challenges are ESBL-producing Enterobacteriaceae with carbapenemase, multi-resistant Pseudomonas, and highly virulent community-acquired methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin. Antibiotic auditing programs and meticulous patient training by nurses are the only available defense at the moment. Novel approaches such as antibiotic-impregnated Tenckhoff catheters, biocompatible dialysis fluid, and peritoneal immuno-augmentation strategies are eagerly awaited. Copyright © 2007 International Society for Peritoneal Dialysis. Printed in Canada. All rights reserved.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationPeritoneal Dialysis International, 2007, v. 27 SUPPL. 2, p. S272-S280 [How to Cite?]
 
dc.identifier.epageS280
 
dc.identifier.isiWOS:000257889500048
 
dc.identifier.issn0896-8608
2012 Impact Factor: 2.214
2012 SCImago Journal Rankings: 0.773
 
dc.identifier.issueSUPPL. 2
 
dc.identifier.pmid17556319
 
dc.identifier.scopuseid_2-s2.0-35748981532
 
dc.identifier.spageS272
 
dc.identifier.urihttp://hdl.handle.net/10722/159061
 
dc.identifier.volume27
 
dc.languageeng
 
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
 
dc.publisher.placeCanada
 
dc.relation.ispartofPeritoneal Dialysis International
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAnti-Bacterial Agents - Pharmacology
 
dc.subject.meshCatheters, Indwelling - Microbiology
 
dc.subject.meshDrug Resistance, Bacterial
 
dc.subject.meshHumans
 
dc.subject.meshKidney Failure, Chronic - Therapy
 
dc.subject.meshPeritoneal Dialysis
 
dc.subject.meshPeritonitis - Drug Therapy - Microbiology
 
dc.subject.meshRisk Factors
 
dc.titleEvolution of antibiotic resistance mechanisms and their relevance to dialysis-related infections
 
dc.typeConference_Paper
 
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<description.abstract>As the survival of patients with end-stage renal failure has improved, their exposure to antibiotics has also increased. Infections, especially peritoneal dialysis-related peritonitis, are unavoidable because of lapses in technique and the stow worsening of systemic and peritoneal defense associated with aging and dialysis. The selective pressure inherent in the use of antibiotics shapes the pattern of antibiotic resistance in the bacteria causing peritonitis and extraperitoneal infections, and vice versa. Renal function-preserving and non-ototoxic regimens that incorporate double &#946;-lactams (first- and third-generation cephalosporins) for peritonitis have increased the selective pressure in favor of methicillin-resistant staphylococci (HRS) and extended-spectrum &#946;-lactamase (ESBL)-producing Enterobacteriaceae. Attempts to use the fluoroquinolones as alternatives to &#946;-lactams was met with rocketing quinolone resistance. The high incidence of MRS led many nephrologists to use empiric vancomycin - until the d&#233;but of vancomycin-resistant enterococci. The recent emergence of heterogeneous and high-level vancomycin resistance in staphylococci (which are especially prevalent in patients on dialysis) calls for further prudence in the use of vancomycin. The coming challenges are ESBL-producing Enterobacteriaceae with carbapenemase, multi-resistant Pseudomonas, and highly virulent community-acquired methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin. Antibiotic auditing programs and meticulous patient training by nurses are the only available defense at the moment. Novel approaches such as antibiotic-impregnated Tenckhoff catheters, biocompatible dialysis fluid, and peritoneal immuno-augmentation strategies are eagerly awaited. Copyright &#169; 2007 International Society for Peritoneal Dialysis. Printed in Canada. All rights reserved.</description.abstract>
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<subject.mesh>Catheters, Indwelling - Microbiology</subject.mesh>
<subject.mesh>Drug Resistance, Bacterial</subject.mesh>
<subject.mesh>Humans</subject.mesh>
<subject.mesh>Kidney Failure, Chronic - Therapy</subject.mesh>
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Author Affiliations
  1. The University of Hong Kong