Antimicrobial-resistant, gram-positive bacteria among patients undergoing chronic hemodialysis

Numerous antimicrobial-resistant pathogens (ARPs) have emerged among patients who undergo chronic hemodialysis (CHD), including vancomycin-resistant enterococci, vancomycin-resistant coagulase-negative staphylococci, Staphylococcus aureus with reduced susceptibility to vancomycin, and linezolid-resistant S. aureus. In June 2002, the first isolate of vancomycin-resistant S. aureus (minimum inhibitory concentration of vancomycin, greater than or equal to32 mg/mL) was isolated in the United States from a patient who required CHD. Frequent administration of antibiotics and repeated exposure to settings conducive to cross-transmission contribute to a patient population at considerable risk of harboring ARPs. Dissemination of ARPs among patients who are undergoing CHD is facilitated by the requirement for regular hemodialysis in a closed setting in which health care workers provide concurrent care to multiple patients. Frequent hospitalizations in this patient population further contribute to acquisition of ARPs and to the spread of ARPs to other hospitalized patients. The epidemiology of antimicrobial-resistant, gram-positive pathogens in patients undergoing CHD is reviewed, and recommendations for limiting further dissemination are provided.