Vancomycin Resistance in Staphylococci

Background and objectives Coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-related peritonitis in many centers. This study aimed to describe clinical and microbiologic characteristics of 115 CNS episodes and to determine factors influencing the outcome.Design, setting, participants, & measurements This study reviewed the records of 115 CNS peritonitis episodes that occurred in 74 patients between 1994 and 2011 at a single university center. Peritonitis incidences were calculated for three consecutive 6-year periods (P1, 1994-1999; P2, 2000-2005; P3, 2006-2011) and annually. The production of biofilms, enzymes, and toxins was evaluated. Oxacillin resistance was evaluated based on its minimum inhibitory concentration and the presence of the mecA gene.Results The overall incidence of CNS peritonitis was 0.15 episodes per patient per year and did not vary over time (0.12, 0.14, and 0.16 for P1, P2, and P3, respectively; P=0.21). The oxacillin resistance rate was 69.6%. Toxin and enzyme production was infrequent and 36.5% of CNS strains presented the gene encoding biofilm production. The presence of icaAD genes associated with biofilm production was predictive of relapses or repeat episodes (odds ratio [OR], 2.82; 95% confidence interval [95% CI], 1.11 to 7.19; P=0.03). Overall, 70 episodes (60.9%) resolved; oxacillin susceptibility (OR, 4.41; 95% CI, 1.48 to 13.17; P=0.01) and vancomycin use as the first treatment (OR, 22.27; 95% CI, 6.16 to 80.53; P,0.001) were the only independent predictors of resolution.Conclusions Oxacillin resistance and vancomycin use as the first treatment strongly influence the resolution rate in CNS peritonitis, which reinforces the validity of the International Society for Peritoneal Dialysis guidelines on monitoring bacterial resistance to define protocols for initial treatment. These results also suggest that the presence of biofilm is a potential cause of repeat peritonitis episodes.

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“…Resistance to vancomycin is seldom observed in staphylococci, even in CNS in which glycopeptide resistance is more frequent (40).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

Camargo

Cunha

Júnior

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…It represents a serious clinical problem and has created a need for the development of new antimicrobial agents to treat these infections. With the appearance of methicillin-resistant (MR) and vancomycin-resistant (VR) grampositive pathogens, the need for different therapeutic agents is greatly increased, and it has become critical to identify effective agents to treat multidrug-resistant gram-positive infections with novel mechanisms of activity (4,12,13,14,16,20).…”

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confidence: 99%

In Vitro Activity and Killing Effect of Uperin 3.6 against Gram-Positive Cocci Isolated from Immunocompromised Patients

Giacometti

Cirioni

Kamysz

et al. 2005

Antimicrob Agents Chemother

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“…It is also the chosen antibiotic to treat bacterial infections in patients allergic to β-lactam antibiotics. Today, vancomycin resistant Staphylococcus aureus strains are a serious concern [4][5][6] .…”

Section: Vancomycin Is a Glycopeptide Antibiotic First Isolated In 19mentioning

confidence: 99%

Analytical methods for vancomycin determination in biological fluids and in pharmaceuticals

et al. 2007

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Recebido em 25/8/05; aceito em 7/4/06; publicado na web em 31/10/06Vancomycin is a glycopeptide antibiotic employed in the treatment of infections caused by certain methicillin-resistant staphylococci. It is indicated also for patients allergic to penicillin or when there is no response to penicillins or cephalosporins. The adequate vancomycin concentration levels in blood serum lies between 5 and 10 mg/L. Higher values are toxic, causing mainly nephrotoxicity and ototoxicity. Various analytical methods are described in the literature: spectrophotometric, immunologic, biologic and chromatographic methods. This paper reviews the main analytical methods for vancomycin determination in biological fluids and in pharmaceutical preparations.

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Vancomycin Resistance in Staphylococci

Cited by 227 publications

References 77 publications

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

Peritoneal Dialysis–Related Peritonitis due to Coagulase-Negative Staphylococcus

In Vitro Activity and Killing Effect of Uperin 3.6 against Gram-Positive Cocci Isolated from Immunocompromised Patients

Analytical methods for vancomycin determination in biological fluids and in pharmaceuticals

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