title: Appropriateness of empiric gentamicin and vancomycin therapy for bacteremias in chronic dialysis outpatient units in the era of antibiotic resistance.
abstract: Bacteremias in inpatient chronic HD units have been described, but there is little information on bacteremias in ambulatory HD units. To determine the frequency of bacteremia and pathogen distribution in ambulatory chronic HD units, we retrospectively reviewed our experience with 107 bacteremias in 5 chronic ambulatory HD units over a 3 year period. The object of the study was twofold. The first objective was to determine if bacteremias in ambulatory HD setting were substantially different in frequency or type than in the inpatient HD setting. Secondly, febrile patients suspected of having bacteremia in chronic HD patients are often empirically treated with vancomycin and gentamicin. Chronic HD patients require repeated and frequent venous access for HD. Bacteremias are common in chronic HD patients and may be primary or secondary and are often related to venous access site infections. The distributions of bacteremia pathogens in chronic HD patients are predominantly reflective of skin flora, i.e., staphylococci and to lesser extent aerobic Gram-negative bacilli. After S. aureus (MSRA/MSSA) and coagulase-negative staphylococcus (CoNS), enterococci are the next most important Gram-positive pathogens in bacteremic HD patients. Most strains of E. faecalis are sensitive to vancomycin and for practical purposes should be considered as vancomycin sensitive enterococci (VSE). In contrast, most strains of E. faecium are resistant to vancomycin and should be considered as vancomycin resistant enterococci (VRE). We retrospectively reviewed 107 patients on chronic ambulatory HD to determine the adequacy of empiric vancomycin and gentamicin prophylaxis. We found amikacin is preferred to gentamicin and that meropenem is an effective alternate substitution for gentamicin and vancomycin combination therapy.
authors.affiliation: Infectious Disease Division and Microbiology Laboratory, Winthrop-University Hospital, Mineola, New York , New York 11501, USA.
authors.forename: V
authors.initials: V
authors.lastname: Krol
authors.forename: B A
authors.initials: BA
authors.lastname: Cunha
authors.forename: P E
authors.initials: PE
authors.lastname: Schoch
authors.forename: N C
authors.initials: NC
authors.lastname: Klein
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology*; D004359:Drug Therapy, Combination; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D005839:Gentamicins / Q000627:therapeutic use*; D006436:Hemodialysis Units, Hospital / Q000458:organization & administration; D006801:Humans; D010045:Outpatients; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D040141:Staphylococcaceae / Q000187:drug effects / Q000302:isolation & purification; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D005839:Gentamicins; D014640:Vancomycin