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Conference Paper: Evolution of antibiotic resistance mechanisms and their relevance to dialysis-related infections

TitleEvolution of antibiotic resistance mechanisms and their relevance to dialysis-related infections
Authors
Issue Date2007
PublisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
Citation
Peritoneal 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.
Persistent Identifierhttp://hdl.handle.net/10722/159061
ISSN
2015 Impact Factor: 1.298
2015 SCImago Journal Rankings: 0.683
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, SSYen_US
dc.contributor.authorHo, PLen_US
dc.contributor.authorYuen, KYen_US
dc.date.accessioned2012-08-08T09:06:08Z-
dc.date.available2012-08-08T09:06:08Z-
dc.date.issued2007en_US
dc.identifier.citationPeritoneal Dialysis International, 2007, v. 27 SUPPL. 2, p. S272-S280en_US
dc.identifier.issn0896-8608en_US
dc.identifier.urihttp://hdl.handle.net/10722/159061-
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.en_US
dc.languageengen_US
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.comen_US
dc.relation.ispartofPeritoneal Dialysis Internationalen_US
dc.subject.meshAnti-Bacterial Agents - Pharmacologyen_US
dc.subject.meshCatheters, Indwelling - Microbiologyen_US
dc.subject.meshDrug Resistance, Bacterialen_US
dc.subject.meshHumansen_US
dc.subject.meshKidney Failure, Chronic - Therapyen_US
dc.subject.meshPeritoneal Dialysisen_US
dc.subject.meshPeritonitis - Drug Therapy - Microbiologyen_US
dc.subject.meshRisk Factorsen_US
dc.titleEvolution of antibiotic resistance mechanisms and their relevance to dialysis-related infectionsen_US
dc.typeConference_Paperen_US
dc.identifier.emailWong, SSY:samsonsy@hkucc.hku.hken_US
dc.identifier.emailHo, PL:plho@hkucc.hku.hken_US
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_US
dc.identifier.authorityWong, SSY=rp00395en_US
dc.identifier.authorityHo, PL=rp00406en_US
dc.identifier.authorityYuen, KY=rp00366en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid17556319-
dc.identifier.scopuseid_2-s2.0-35748981532en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-35748981532&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume27en_US
dc.identifier.issueSUPPL. 2en_US
dc.identifier.spageS272en_US
dc.identifier.epageS280en_US
dc.identifier.isiWOS:000257889500048-
dc.publisher.placeCanadaen_US
dc.identifier.scopusauthoridWong, SSY=13310021400en_US
dc.identifier.scopusauthoridHo, PL=7402211363en_US
dc.identifier.scopusauthoridYuen, KY=36078079100en_US

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