Drug-Resistant Pathogens Threaten ESRD Patients by ProQuest


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									26 Renal & Urology News                       FEBRUARY 2010   www.renalandurologynews.com


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:
                                                                                                  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-

                                                                                                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

      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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