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
2011 Impact Factor: 2.097
2011 SCImago Journal Rankings: 0.091
ISI Accession Number IDWOS:000257889500048
ReferencesReferences in Scopus
DC Field
Value
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
2011 Impact Factor: 2.097
2011 SCImago Journal Rankings: 0.091
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
Author Affiliations
  1. The University of Hong Kong