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 Antibiotic Resistance inStaphylococcus aureusand Coagulase Negative Staphylococci Isolated from Goats with Subclinical Mastitis

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Salvatore Virdis ◽  
Christian Scarano ◽  
Francesca Cossu ◽  
Vincenzo Spanu ◽  
Carlo Spanu ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Staphylococcus Epidermidis ◽  
Antimicrobial Agents ◽  
Methicillin Resistance ◽  
Subclinical Mastitis ◽  
Resistance Rate ◽  
Coagulase Negative Staphylococci ◽  
Milk Samples ◽  
Gene Coding ◽  
Resistance Patterns

Antimicrobial resistance patterns and gene coding for methicillin resistance (mecA) were determined in 25S. aureusand 75 Coagulase Negative Staphylococci (CNS) strains isolates from half-udder milk samples collected from goats with subclinical mastitis. Fourteen (56.0%)S. aureusand thirty-one (41.3%) CNS isolates were resistant to one or more antimicrobial agents.S. aureusshowed the highest resistance rate against kanamycin (28.0%), oxytetracycline (16.0%), and ampicillin (12.0%). The CNS tested were more frequently resistant to ampicillin (36.0%) and kanamycin (6.7%). Multiple antimicrobial resistance was observed in eight isolates, and oneStaphylococcus epidermidiswas found to be resistant to six antibiotics. ThemecAgene was not found in any of the tested isolates. Single resistance againstβ-lactamics or aminoglicosides is the most common trait observed while multiresistance is less frequent.

scholarly journals Antimicrobial resistance profiles of microorganisms isolated from hospitalized patients in Dominican Republic

2020 ◽  
Vol 44 ◽  
pp. 1
Author(s):  
David de Luna ◽  
José Javier Sánchez ◽  
Miguel Peguero ◽  
Wilmary García ◽  
Sylmari Liciaga ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Dominican Republic ◽  
Methicillin Resistance ◽  
Carbapenem Resistance ◽  
Generation Cephalosporin ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Coagulase Negative Staphylococci ◽  
Cross Sectional ◽  
Acinetobacter Spp

Objective. To define the antimicrobial resistance profiles of the microorganisms most commonly isolated from hospitalized adult patients in Dominican Republic (DR). Methods. A retrospective, cross-sectional study of phenotypic antimicrobial susceptibility patterns was conducted using data from 3 802 clinical microbiology reports specifying positive bacterial cultures in samples collected from patients admitted to the clinical, surgery, and intensive care units (ICU) at three tertiary-level care hospitals in the city of Santiago de los Caballeros from 1 January 2016 – 31 December 2017. Descriptive statistics and chi-square test (P ≤ 0.05) were used to analyze the qualitative variables. Results. At the three hospitals, there were 932, 1 090, and 1 780 microbiology reports analyzed. Of the total, 1274 were from the ICU, 1 042 from the surgery unit, and 1 486 from the clinical unit. Methicillin resistance was found in 57.3% of the Staphylococcus aureus isolates and 75.3% of the coagulase-negative staphylococci. Third-generation cephalosporin resistance was detected in 54.4% of isolates identified as members of the Enterobacteriaceae family, 67.3% of the Acinetobacter spp., and 91.7% of the Pseudomonas, while carbapenem resistance was shown by 8.0%, 23.8%, and 51.0% of these, respectively. Most of the resistant Acinetobacter spp. isolates were found in just one hospital and the prevalence of Enterobacteriaceae resistant to carbapenems was highest in the ICU. Conclusion. Antimicrobial resistance levels are high among hospitalized patients in Dominican Republic and may cause enhanced risk factors that impact clinical outcomes. Urgent measures are needed to address antimicrobial resistance in DR.

Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

2020 ◽  
Vol 40 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M Pascoe ◽  
Carmel Hawley ◽  
Philip A Clayton ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Primary Outcome ◽  
Catheter Removal ◽  
Dialysis Patients ◽  
Gram Positive ◽  
Pseudomonas Species ◽  
Gram Negative Organisms ◽  
Culture Positive ◽  
Culture Negative ◽  
Related Mortality

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

scholarly journals Tailoring Antimicrobial Susceptibility Testing to Individual Species of Coagulase-Negative Staphylococci: Next Up, Staphylococcus epidermidis

2019 ◽  
Vol 57 (12) ◽  
Author(s):  
C. Paul Morris ◽  
Patricia J. Simner
Keyword(s):  
Antimicrobial Susceptibility ◽  
Staphylococcus Epidermidis ◽  
Susceptibility Testing ◽  
Methicillin Resistance ◽  
Antimicrobial Susceptibility Testing ◽  
Individual Species ◽  
Beta Lactam ◽  
Coagulase Negative Staphylococci ◽  
Content Type ◽  
Species Specific

ABSTRACT Accurate detection of methicillin resistance among staphylococci is vital for patient care. Methicillin resistance is most commonly mediated by acquisition of the mecA gene, which encodes an altered penicillin binding protein, PBP2a. Application of phenotypic methods to detect mecA-mediated beta-lactam resistance in staphylococci is becoming more complex as species-specific differences are identified among coagulase-negative staphylococci (CoNS). Previously, interpretative criteria and antimicrobial susceptibility testing (AST) methods specific to the CoNS group were used to evaluate Staphylococcus epidermidis. A manuscript by S. N. Naccache, K. Callan, C.-A. D. Burnham, M. A. Wallace, et al. (J Clin Microbiol 57:e00961-19, 2019, https://doi.org/10.1128/JCM.00961-19) details experiments revealing that S. epidermidis, the most common clinically isolated CoNS, requires tailored use of previously described methods and interpretive criteria to reliably identify the presence of mecA-mediated methicillin resistance.

Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

2002 ◽  
Vol 22 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Robert E. Ariano ◽  
Christine Franczuk ◽  
Adrian Fine ◽  
Godfrey K.M. Harding ◽  
Sheryl A. Zelenitsky
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Significant Risk ◽  
Response Rates ◽  
Care Hospital ◽  
Clinical Failure ◽  
Empiric Treatment

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

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.

Microbiology and Outcomes of Peritonitis in Australian Peritoneal Dialysis Patients

2011 ◽  
Vol 31 (6) ◽  
pp. 651-662 ◽  
Author(s):  
Joanna R. Ghali ◽  
Kym M. Bannister ◽  
Fiona G. Brown ◽  
Johan B. Rosman ◽  
Kathryn J. Wiggins ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Single Agent ◽  
Catheter Removal ◽  
Fungal Peritonitis ◽  
Gram Negative ◽  
Single Organism ◽  
Transplant Registry ◽  
Anaerobic Infections ◽  
Gram Negative Organisms ◽  
Culture Negative

We analyzed data from the Australia and New Zealand Dialysis and Transplant Registry for 1 October 2003 to 31 December 2008 with the aim of describing the nature of peritonitis, therapies, and outcomes in patients on peritoneal dialysis (PD) in Australia.At least 1 episode of PD was observed in 6639 patients. The overall peritonitis rate was 0.60 episodes per patient–year (95% confidence interval: 0.59 to 0.62 episodes), with 6229 peritonitis episodes occurring in 3136 patients. Of those episodes, 13% were culture-negative, and 11% were polymicrobial. Gram-positive organisms were isolated in 53.4% of single-organism peritonitis episodes, and gram-negative organisms, in 23.6%. Mycobacterial and fungal peritonitis episodes were rare. Initial antibiotic therapy for most peritonitis episodes used 2 agents (most commonly vancomycin and an aminoglycoside); in 77.2% of episodes, therapy was subsequently changed to a single agent. Tenckhoff catheter removal was required in 20.4% of cases at a median of 6 days, and catheter removal was more common in fungal, mycobacterial, and anaerobic infections, with a median time to removal of 4 – 5 days. Peritonitis was the cause of death in 2.6% of patients. Transfer to hemodialysis and hospitalization were frequent outcomes of peritonitis. There was no relationship between center size and peritonitis rate. The peritonitis rate in Australia between 2003 and 2008 was higher than that reported in many other countries, with a particularly higher rate of gram-negative peritonitis.

Evaluation of phenotypic methods for methicillin resistance characterization in coagulase-negative staphylococci (CNS)

2004 ◽  
Vol 53 (12) ◽  
pp. 1195-1199 ◽  
Author(s):  
Juliana Caierão ◽  
Maiara Musskopf ◽  
Silvana Superti ◽  
Eliane Roesch ◽  
Cícero G Dias ◽  
...  
Keyword(s):  
Nosocomial Infections ◽  
Staphylococcus Epidermidis ◽  
Methicillin Resistance ◽  
Common Species ◽  
Disc Diffusion ◽  
Coagulase Negative Staphylococci ◽  
Resistant Strains ◽  
Staphylococcus Hominis ◽  
Phenotypic Methods ◽  
Microscan System

Coagulase-negative staphylococci (CNS) are the major cause of nosocomial infections. Methicillin-resistant strains are particularly important because they narrow therapeutic options. Detecting methicillin resistance among CNS has been a challenge for years. The objective of this study was to determine the accuracy of an agar screening test (0.6 and 4 μg oxacillin ml−1), disc diffusion and the automated MicroScan system to characterize methicillin resistance among CNS. One hundred and seventy five strains were analysed: 41.1 % Staphylococcus epidermidis and 59.9 % other species; 69.1 % were mecA-positive. The results showed that the methods have optimal correlation with the detection of mecA gene for S. epidermidis, Staphylococcus hominis and Staphylococcus haemolyticus. However, accuracy of the tests is impaired when less common species are analysed. The only 100 % accurate test was agar screening with 4 μg oxacillin ml−1.

scholarly journals Canadian Patterns of Antimicrobial Resistance: Overview of Current Trends Related to Hospital Pathogens

2006 ◽  
Vol 17 (suppl b) ◽  
pp. 3B-5B
Author(s):  
Tony Mazzulli
Keyword(s):  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Geographical Location ◽  
Current Data ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Gram Negative ◽  
Canadian Data ◽  
Gram Negative Organisms ◽  
Resistance Rates

Selection of appropriate empirical antibiotic therapy is dependent on many factors, not the least of which is an understanding of antimicrobial resistance rates in the patient population that is undergoing treatment. Resistance rates may vary by geographical location, institution, hospital ward or unit, and even body site of infection. The present paper reviews the currently available Canadian data regarding resistance rates for some of the most common hospital-acquired pathogens, includingEscherichia coli,Klebsiellaspecies,Pseudomonas aeruginosa,Enterobacterspecies,Staphylococcus aureusandEnterococcusspecies. Current data suggest that the rates of extended-spectrum beta-lactamases amongE coliandKlebsiellaspecies remain relatively low across Canada. There are very little data on the epidemiology of ampC cephalosporinases among Gram-negative organisms, although combined American and Canadian data suggest that ceftazidime resistance rates forEnterobacterspecies range from 17.1% to 24.8%. The increased use of fluoroquinolones has led to an increase in resistance rates among most Gram-negative organisms. In the late 1990s, ciprofloxacin resistance rates forP aeruginosawere reported to be approximately 20%. For the Gram-positive organisms, methicillin resistance rates forS aureushave been reported to be as high as 10% and vancomycin resistance rates forEnterococcusspecies have been reported to be less than 1%. Additional data that are representative of all regions of Canada are needed. Continued surveillance, antibiotic stewardship, and adherence to good infection prevention and control measures will lead to a better understanding of the epidemiology of antimicrobial resistance in Canadian hospitals, as well as help to control its spread.

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