A 12-Month Review of Peritoneal Dialysis-Related Peritonitis in Western Australia: Is Empiric Vancomycin Still Indicated for Some Patients?

2003 ◽  
Vol 23 (5) ◽  
pp. 465-468 ◽  
Author(s):  
George W. Kan ◽  
Mark A.B. Thomas ◽  
Christopher H. Heath
Keyword(s):  
Peritoneal Dialysis ◽  
Western Australia ◽  
Methicillin Resistance ◽  
Patient Characteristics ◽  
Empiric Therapy ◽  
University Hospitals ◽  
Coagulase Negative Staphylococci ◽  
Fungal Peritonitis ◽  
Specific Patient ◽  
Methicillin Resistant

Background The International Society for Peritoneal Dialysis (ISPD) guidelines recommend empiric therapy with cefazolin and ceftazidime for peritoneal dialysis (PD)-related peritonitis. Empiric cefazolin therapy may have diminishing efficacy because of emerging methicillin resistance in gram-positive bacteria (GPB). Western Australia also has large numbers of Aboriginal and isolated regional patients, where giving these antimicrobials can be impractical. Objectives To evaluate, based on local antimicrobial resistance patterns, the feasibility of following ISPD guidelines in Western Australia and to identify any subgroups of PD peritonitis patients that may benefit from alternative empiric intraperitoneal antibiotics ( e.g., vancomycin). Study Design Retrospective study of all PD peritonitis episodes in Western Australia from 1 February 2000 to 31 January 2001. Setting Three adult tertiary referral university hospitals and their PD patients in metropolitan Perth and regional Western Australia. Patients All adults on PD in Western Australia. Main Outcome Measure Isolates and antibiograms were analyzed versus patient characteristics, including race and patient demographics. Results 293 patients (28% Aborigines, 32% regional patients) received PD. 145 episodes of PD peritonitis occurred during the study. The overall PD peritonitis rate was 1 episode/16 patient months, with Aborigines having 1 episode/10.5 patient months versus non-Aborigines having 1 episode/17 patient months p (< 0.001). 36% of isolates from PD peritonitis episodes were resistant to cefazolin or ceftazidime. 22% were methicillin-resistant GPB (MR-GPB) [18% coagulase-negative staphylococci (CoNS), 1.6% MR Staphylococcus aureus]; 2.5% were multidrug-resistant gram-negative bacteria (MDR-GNB); 5.7% were polymicrobial (MR-GPB and/or MDR-GNB); and 5.7% were fungal. 63% of CoNS were methicillin resistant. Non-Aboriginal patients yielded MR-GPB in 22% of isolates versus 23% in Aborigines ( p = 0.9). Six of seven cases of fungal peritonitis occurred inAboriginal patients ( p < 0.001). Conclusions In our study population the ISPD guidelines were appropriate for 64% of patients with PD peritonitis. We could not identify specific patient subgroups where empiric cefazolin use could be more effective. High proportions of MR-GPB PD peritonitis episodes, along with local factors, make empiric cefazolin unsuitable for many regional PD patients in Western Australia.

IncreasingStaphylococcusSpecies Resistance in Peritoneal Dialysis-Related Peritonitis Over a 10-Year Period in a Single Taiwanese Center

2018 ◽  
Vol 38 (4) ◽  
pp. 266-270 ◽  
Author(s):  
Ho-Ching Chen ◽  
Chi-Chang Shieh ◽  
Junne-Ming Sung
Keyword(s):  
Peritoneal Dialysis ◽  
Methicillin Resistance ◽  
Removal Rate ◽  
Staphylococcal Infection ◽  
Resistance Rate ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Methicillin Resistant ◽  
Gram Positive Bacteria ◽  
Southern Taiwan

BackgroundPeritonitis is a major complication of peritoneal dialysis (PD). Staphylococcus species are gram-positive bacteria that are most commonly associated with peritoneal peritonitis. The increasing antimicrobial resistance rate is a severe burden when considering the initial choice of antibiotics. This investigation examined the trends of staphylococcal infection as well as the resistance rate and clinical outcomes from 2006 to 2015 in southern Taiwan.MethodsWe retrospectively investigated all PD-related peritonitis episodes in southern Taiwan between January 2006 and December 2015 and evaluated the clinical characteristics of peritonitis, microbiological prevalence and resistance of Staphylococcus species, and outcomes in patients.ResultsAmong 244 episodes of peritonitis, Staphylococcus species accounted for approximately 65% of the gram-positive bacteria that caused the infection. The methicillin resistance rate among Staphylococcus species substantially increased to 64% by 2015 in both Staphylococcus aureus and coagulase-negative staphylococci in southern Taiwan. Notably, patients with methicillin-resistant staphylococcal infection exhibited a significantly higher hospitalization rate than those with methicillin-sensitive staphylococcal infection. However, the catheter removal rate and transfer to hemodialysis exhibited no differences between the 2 groups.ConclusionPeritonitis is the most serious complication in patients on PD, and microbiological trends have changed over the past 10 years at a single center in southern Taiwan. The number of methicillin-resistant Staphylococcus species has substantially increased. Empirical initial antibiotic therapy should be adapted on the basis of the growing microbiological resistance.

scholarly journals Frequency and Antimicrobial Susceptibility of Bacterial Agents Causing Peritoneal Dialysis-Related Peritonitis: A Two-Center Experience

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Fariba Shirvani ◽  
Nakysa Hooman ◽  
Abdollah Karimi ◽  
Shahnaz Armin ◽  
Alireza Fahimzad ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Therapeutic Option ◽  
Intraperitoneal Administration ◽  
Clinical Manifestations ◽  
Empiric Therapy ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Oxacillin Resistance ◽  
Gram Negative Organisms

Background: Peritonitis remains a significant complication of peritoneal dialysis (PD) in children. Objectives: The current study aimed to evaluate the causative agents of PD-related peritonitis in pediatric patients treated by continuous ambulatory peritoneal dialysis (CAPD) in order to provide evidence for improving the empirical treatment of PD-related peritonitis and avoid antimicrobial resistance. Methods: The medical records of children diagnosed with PD-related peritonitis hospitalized at Mofid and Ali-Asghar Children’s Hospitals from January 2018 to December 2019 were retrospectively reviewed. Cases of relapsing peritonitis and fungal peritonitis were excluded. Data on demographics, clinical manifestations, para-clinical evaluations, peritoneal fluid culture and antibiogram, and antibiotic regimen were analyzed. Results: A total of 23 CAPD children aged 1 - 17 years were hospitalized with a confirmed diagnosis of PD-related peritonitis, accounting for a total of 27 peritonitis cases. The most frequent manifestation of peritonitis was cloudy dialysate (85.2%), followed by abdominal pain (59.3%). Gram-negative organisms were isolated in 48.1% of cases, and 4 cases had negative cultures. The frequency of antibiotic prescription within 14 days of admission was significantly higher in culture-negative cases (P = 0.002), and abdominal pain was more prevalent in Gram-negative peritonitis (P = 0.004). All Gram-negative organisms were sensitive to ceftazidime and imipenem; while 61.6% of them were sensitive to gentamycin. All Gram-positive organisms were sensitive to cefazolin, and vancomycin was effective against all Staphylococcus strains. Oxacillin resistance was reported in 50% of Staphylococcus strains. Conclusions: PD-related peritonitis should be suspected even in cases with clear dialysis effluent who present with other manifestations of peritonitis such as fever or abdominal pain. Moreover, intraperitoneal administration of a first-generation cephalosporin (cefazolin) combined with ceftazidime was an appropriate therapeutic option for empiric therapy.

scholarly journals Evaluation of Screening and Commercial Methods for Detection of Methicillin Resistance in Coagulase-Negative Staphylococci

1998 ◽  
Vol 36 (1) ◽  
pp. 273-274 ◽  
Author(s):  
Zafar Hussain ◽  
Luba Stoakes ◽  
Robert Lannigan ◽  
Susan Longo ◽  
Barbara Nancekivell
Keyword(s):  
Clinical Laboratory ◽  
Methicillin Resistance ◽  
Disk Diffusion ◽  
National Committee ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Resistant Strains ◽  
Time To Detection ◽  
Combination Of Methods ◽  
The Times

The National Committee for Clinical Laboratory Standards recommends 48 h of incubation by the oxacillin salt agar screen (OSAS) method for the detection of methicillin-resistant coagulase-negative staphylococci (CoNS). An earlier identification of methicillin resistance is desirable. The time to detection of the mecAgene by PCR was compared with the times to detection by OSAS, by the oxacillin disk diffusion (ODD) method, and with MicroScan Gram Positive Combo type 6 panels (MicroScan Inc. Sacramento, Calif.) and Vitek GPS-SA cards (bioMérieux Vitek Inc., Hazelwood, Mo.). The combination of the Vitek card and the ODD method detected 92 of 99 methicillin-resistant strains of CoNS at 24 h; however, 6mecA-positive strains were phenotypically methicillin susceptible. We conclude that most methicillin-resistant CoNS can be detected and the results can be reported after overnight incubation by a combination of methods.

Case 23

2020 ◽  
pp. 151-157
Author(s):  
Hilary Humphreys
Keyword(s):  
Peritoneal Dialysis ◽  
Recurrent Infection ◽  
Positive Culture ◽  
Personal Hygiene ◽  
Peritoneal Dialysis Catheter ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Fungal Peritonitis ◽  
Gram Positive Bacteria ◽  
Culture Negative

Infection is one of the commonest complications of continuous ambulatory peritoneal dialysis (CAPD) which often presents with a cloudy bag and sometimes abdominal pain. Gram-positive bacteria, such as coagulase negative staphylococci, are the commonest cause. The diagnosis is confirmed by markedly elevated white cells in the CAPD fluid and a positive culture. Empiric antibiotics should cover Gram-positive and Gram-negative bacteria—e.g intra-peritoneal vancomycin and gentamicin—which are modified when culture and antibiotic susceptibility results are available. Removal of the peritoneal dialysis catheter is indicated in pseudomonal and fungal peritonitis and when there is recurrent infection. Culture-negative CAPD infection may be due to tuberculosis. Minimizing infection is largely achieved through good standards of personal hygiene, patient training and education, and home visits.

scholarly journals Methicillin-resistant coagulase-negative staphylococci in healthy dogs

2017 ◽  
Vol 62 (No. 9) ◽  
pp. 479-487 ◽  
Author(s):  
J. Siugzdaite ◽  
A. Gabinaitiene
Keyword(s):  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Meca Gene ◽  
Diffusion Method ◽  
Coagulase Negative Staphylococcus ◽  
Coagulase Negative Staphylococci ◽  
Phenotypic Properties ◽  
Methicillin Resistant ◽  
Healthy Dogs ◽  
Resistance Rates

The objective of this study was to evaluate the prevalence of coagulase-negative staphylococci in healthy dogs and to determine whether methicillin-resistant staphylococci expressed the mecA gene. Nasal and rectal swab samples were taken from 50 clinically healthy dogs. The prevalence of coagulase-negative staphylococci was evaluated according to phenotypic properties. The agar diffusion method was applied to evaluate antimicrobial resistance and the prevalence of methicillin resistance was determined using PCR analysing the mecA gene. A total of 59 coagulase-negative staphylococcus strains were isolated from the nostrils and rectums of 37 (74%) clinically healthy dogs. The prevalence of coagulase-negative staphylococci in female dogs was significantly higher compared with male dogs (P &lt; 0.05). The results of antimicrobial susceptibility testing showed that 6.7% of the strains were resistant to oxacillin, 23.7% were resistant to penicillin, 22% to ampicillin and 16.9% to erythromycin. The mecA PCR revealed one oxacillin-sensitive and four oxacillin-resistant coagulase-negative staphylococci strains to be mecA carriers. Staphylococcus sciuri (60%) and Staphylococcus warneri (20%) were the most prevalent species among methicillin-resistant coagulase negative staphylococci. High antimicrobial resistance rates for these bacteria were observed against penicillin (100%), ampicillin (100%), oxacillin (80%), erythromycin (80%) and gentamicin (60%). All strains were susceptible to vancomycin and enrofloxacin. It is assumed that methicillin-resistance genes evolved in coagulase-negative staphylococcus and were then horizontally transferred among staphylococci.

Microbiological Trends and Antimicrobial Resistance in Peritoneal Dialysis-Related Peritonitis, 2005 to 2014

2017 ◽  
Vol 37 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Sheryl A. Zelenitsky ◽  
Jacy Howarth ◽  
Philippe Lagacé-Wiens ◽  
Christie Sathianathan ◽  
Robert Ariano ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Antimicrobial Resistance ◽  
Staphylococcus Epidermidis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Coagulase Negative Staphylococci ◽  
Single Organism ◽  
Ciprofloxacin Resistance ◽  
Gram Negative Organisms ◽  
Culture Positive

BackgroundInformation related to the microbiology of peritonitis is critical to the optimal management of patients receiving peritoneal dialysis (PD). The goal was to characterize the microbiological etiology and antimicrobial susceptibilities of PD-related peritonitis (PDRP) from 2005 to 2014, inclusive.MethodsThe distribution of organisms in culture-positive PDRP was described for new episodes and relapse infections, and further detailed for monomicrobial and polymicrobial peritonitis. Annual and overall rates of PDRP were also characterized. Antimicrobial susceptibility rates were calculated for the most common and significant organisms.ResultsWe identified 539 episodes of PDRP including 501 new and 38 relapse infections. New episodes of peritonitis were associated with a single organism in 85% of cases, and 44% of those involved staphylococci. Polymicrobial PDRP was more likely to involve gram-negative organisms, observed in 58% versus 24% of monomicrobial infections. Antimicrobial resistance was relatively stable from 2005 to 2014. Methicillin resistance was present in 57% of Staphylococcus epidermidis and 20% of other coagulase-negative staphylococci. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for only 11% of S. aureus peritonitis compared with 2% in our previous study of PDRP from 1991 to 1998. Ciprofloxacin resistance in Escherichia coli increased from 3% in our previous study to 24% in 2005 – 2014.ConclusionsThis study characterizes important differences in the distribution of organisms in new episodes of PDRP and relapse infections, as well as monomicrobial versus polymicrobial peritonitis. It also shows relatively stable rates of antimicrobial resistance from 2005 to 2014, but some increases compared with our previous study.

scholarly journals Determination of the frequency, species distribution and antimicrobial resistance of staphylococci isolated from dogs and their owners in Trinidad

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254048
Author(s):  
Sharianne Suepaul ◽  
Karla Georges ◽  
Chandrashekhar Unakal ◽  
Filip Boyen ◽  
Jamie Sookhoo ◽  
...  
Keyword(s):  
Multidrug Resistance ◽  
Antimicrobial Resistance ◽  
Species Distribution ◽  
Antimicrobial Agents ◽  
Methicillin Resistance ◽  
Close Contact ◽  
Common Species ◽  
Diffusion Method ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant

The close contact between humans and their dogs can lead to the commingling of staphylococci and the exchange of mobile genetic elements encoding antimicrobial resistance. The objectives of this study were to determine the species distribution and antimicrobial resistance patterns of staphylococci colonizing canine pets and their owners in Trinidad. Staphylococci were isolated from canine pets and their owners and identified using MALDI-TOF mass spectrometry. Antimicrobial susceptibilities were determined using the Kirby-Bauer disc diffusion method against seven classes of antimicrobial agents. A total of 440 staphylococci were isolated from 112 canine pets and their owners, 53.4% were from canine pets and 46.6% were from owners. Twenty-four species were detected, of which, most isolates (32.5%) belonged to the Staphylococcus intermedius group (SIG). S. sciuri was the most common species of coagulase-negative staphylococci (CoNS) comprising 22.3% of all isolates. Antimicrobial resistance was highest against commonly used antimicrobials, such as penicillin (51.4%), tetracycline (26.1%) and trimethoprim/sulfamethoxazole (18.6%). These antimicrobials also comprised the most common multidrug resistance (MDR) combination. Overall, 19.1% of isolates displayed multidrug resistance. No methicillin-resistant Staphylococcus aureus (MRSA) isolates were detected. However, methicillin resistance was detected in 13.3% and 15.1% of coagulase-positive staphylococci (CoPS) and the CoNS+CoVS (combined CoNS and coagulase-variable staphylococci) group respectively. The presence of methicillin-resistant staphylococci is worrisome because there is the potential for the transfer of these strains between dogs and humans. These strains may act as a reservoir of resistance genes.

scholarly journals A study of inducible clindamycin resistance in erythromycin resistant clinical isolates of Staphylococcus species

2015 ◽  
Vol 6 (6) ◽  
pp. 48-52
Author(s):  
Fatima Khan ◽  
Sana Ali ◽  
Asfia Sultan ◽  
Meher Rizvi ◽  
Abida Khatoon ◽  
...  
Keyword(s):  
Methicillin Resistance ◽  
Clinical Isolates ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Clinical Failure ◽  
Coagulase Negative Staphylococci ◽  
Sensitivity Testing ◽  
Disk Diffusion Method ◽  
Methicillin Resistant ◽  
Inducible Clindamycin Resistance

Introduction: Erythromycin resistant Staphylococcus isolates with inducible resistance appear sensitive to clindamycin in in?vitro sensitivity testing. If clindamycin is used for treatment of such isolates, selection for constitutive mutants may lead to clinical failure. Current study was conducted to detect the presence of inducible clindamycin resistance in erythromycin resistant Staphylococcus isolates by disk diffusion method (D test). To correlate clindamycin resistance phenotypes with minimum inhibitory concentrations (MICs) of clindamycin, erythromycin, oxacillin and vancomycin among the isolates. To correlate various resistance phenotypes with methicillin resistance. Material and Methods: 150 non duplicate isolates of Staphylococcus species were identified and antibiotic susceptibility testing was done using Kirby Bauer’s disc diffusion method. MICs were determined using E?test for oxacillin, vancomycin, clindamycin and erythromycin using E?test strips (Himedia) Results: Among 150 staphylococcus clinical isolates, 96 were of S. aureus and 54 were coagulase negative Staphylococci (CONS). About 81.2% of the S.aureus isolates and 72.2% of the CONS were found to be methicillin resistant. Inducible clindamycin resistance was found in 39.3% of the isolates, constitutive resistance phenotype in 48% while 12.7% demonstrated MS phenotype. 18% and 11.3% of all the isolates had MICs for clindamycin between 0.01?0.06 μg/ml and 0.06?0.1 respectively. 12.5% had MIC ranging from 4?8 μg/ml while 58% had MIC > 8 μg/ml. Constitutive resistant phenotype (cMLS) was the predominant phenotype in methicillin resistant isolates. MS phenotype was the predominant among MSSA (methicillin sensitive S. aureus) while MSCNS (methicillin sensitive CONS) cMLS (46.7%) predominated. MIC of all erythromycin resistant isolates were ≥ 240 μg/ml. Nearly 16.7% of the cMLS and 57.9% of MS isolates were found to be oxacillin sensitive and 83% of iMLS and 83.3% of MS phenotype isolates were oxacillin resistant on MIC testing. 47.2% of cMLS and 73.6% of MS isolates had MIC ≤ 2 μg/ml for vancomycin and 52.7% of cMLS and 26.3% of MS isolates had MICs in intermediate range for vancomycin. Conclusions: D?testing might help clinicians to decide whether to use clindamycin in Staphylococcal infections when erythromycin resistance is present. Determination of MICs help to identify exact sensitivity profile of isolates in cases where clinical failure occurs due to misleading disk diffusion tests.DOI: http://dx.doi.org/10.3126/ajms.v6i6.11811 Asian Journal of Medical Sciences Vol.6(6) 2015 48-52

scholarly journals Antibiotic Resistance Trends Among Ocular Pathogens in the US—Cumulative Results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study

2017 ◽  
Vol 10 (01) ◽  
pp. 35 ◽  
Author(s):  
Penny A Asbell ◽  
Christine M Sanfilippo ◽  
◽  
Keyword(s):  
Antibiotic Resistance ◽  
Multidrug Resistance ◽  
Methicillin Resistance ◽  
Surveillance Study ◽  
Health Concern ◽  
Antibacterial Drug ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Resistance Monitoring ◽  
Ongoing Surveillance

Antibiotic resistance among ocular pathogens is a public health concern. The multicenter, prospective Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is an ongoing surveillance study designed to report on antibiotic resistance rates and trends among Staphylococcus aureus, coagulase-negative staphylococci (CoNS; includes Staphylococcus epidermidis), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Results for more than 4,000 isolates collected from 2009 –2015, representing 7 years of ARMOR, were recently presented. More than a third of S. aureus and almost half of all CoNS isolates were found to be resistant to methicillin. Staphylococcal isolates also showed high levels of multidrug resistance (resistance to ≥3 antibacterial drug classes) with 76.4% and 73.7% of methicillin-resistant S. aureus (MRSA) and methicillin-resistant CoNS (MRCoNS) isolates, respectively, demonstrating multidrug resistance. Resistance among S. pneumoniae was notable for azithromycin (36.8%) and for penicillin (34.0%), whereas P. aeruginosa and H. influenzae were generally susceptible to the antibiotic classes tested. Longitudinal analyses demonstrated a small decrease in methicillin resistance among S. aureus over the 7-year study period, which may be a result of improved antibiotic stewardship. Continued surveillance of antibiotic resistance among ocular pathogens is warranted.

Sign in / Sign up

Export Citation Format

Share Document