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26 Renal & Urology News FEBRUARY 2010 www.renalandurologynews.com ■ FEATURE Drug-Resistant Pathogens Threaten ESRD Patients According to researchers, they are responsible for a growing proportion of bloodstream infections in dialysis and renal transplant patients BY JODY A. CHARNOW The results appear in the American Journal of Transplantation (2009;9: 835-843). Infections In a separate study of Pseudomonas aeruginosa bloodstream infections con- On the Rise ducted at the University of Pittsburgh THE INFECTIOUS hospitalization Medical Center, researchers found that rate in the hemodialysis popula- transplant recipients are at greater risk tion over the past 10 years has for multidrug-resistant P. aeruginosa bloodstream infections than non-trans- increased by nearly 40%, accord- © SCIENCE SOURCE / PHOTO RESEARCHERS, INC. plant patients, according to a paper ing to a report in the Clinical published in Transplant Infectious Journal of the American Society of Disease (2009;11:227-234). Researchers Nephrology (2009;4:S5-S11). identiﬁed 503 subjects who experienced In the ﬁrst two months of dialy- P. aeruginosa bloodstream infections sis, infectious hospitalization rates over a 10-year period; 149 were trans- now are almost equal to the rates plant recipients. Of the P. aeruginosa of cardiovascular hospitalization, blood culture isolates from transplant which is of “great concern from recipients, 43% were multidrug resis- a communicable disease stand- Methicillin-resistant Staphylococcus aureus is increasing in frequency. tant compared with 18% of isolates from non-transplant recipients. point,” especially with respect to I nfections are major cause of hos- organ transplant recipients receiv- the emergence of methicillin- pitalization and death in the dialy- ing care at Mayo Clinic in Rochester, MRSA resistant Staphylococcus aureus, sis and transplant populations, Minn. From 1996 to 2007, antimi- researchers noted. and treatment of these infections crobial resistance rates among E. coli In the dialysis population, researchers “The high rate of catheter use could be made more challenging by the bloodstream isolates in solid organ have observed an emerging problem at dialysis initiation is a major con- emergence of pathogens resistant to transplant recipients increased from with methicillin-resistant Staphylococcus cern and may be a contributing multiple antimicrobial agents. 50% to 75% for ampicillin and 0% aureus (MRSA). From 1995 to 2002, the factor to the higher mortality rate “We have observed trends of increasing to 44% for ciproﬂoxacin. “In kidney percentage of dialysis centers treating in the ﬁrst months on dialysis and antimicrobial resistance among Gram- transplant recipients, antimicrobial one or more patients with MRSA rose to infectious hospitalization rates negative bloodstream isolates, particu- resistance rates of E. coli bloodstream from 40% to 76%, according to a report in the ﬁrst year on hemodialysis larly Escherichia coli isolates, in kidney isolates increased from 40% to 74% in Seminars in Dialysis (2005;18:52-61). and other solid organ transplant recipi- for ampicillin and from 0% to 53% for The incidence of invasive MRSA infec- therapy,” the authors wrote. ents,” said Majdi N. Al-Hasan, MD, an ciproﬂoxacin during the same period,” tions among dialysis patients in 2005 was In 2007, 80% of hemodialysis infectious disease specialist now with Dr. Al-Hasan said. 45.2 cases per 1,000 population, indi- patients started dialysis with the Division of Infectious Diseases at the From 2000 to 2007, the prevalence of cating a 100-fold greater risk for these a catheter, according to the University of Kentucky in Lexington. E. coli bloodstream isolates producing inf
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