title: Novel antimicrobial-resistant bacteria among patients requiring chronic hemodialysis.
abstract: OBJECTIVE
  Antimicrobial-resistant bacteria (ARB) including resistant strains of Staphylococcus aureus, enterococci, and Gram-negative bacteria have the potential to cause serious infections among patients requiring chronic hemodialysis (CHD). The purpose of this article is to review novel ARB, which have emerged in this patient population, their mechanisms of transmission, and preventive efforts aimed at limiting their dissemination.
  
  
  RESULTS
  New strains of ARB, including community-acquired methicillin-resistant S. aureus, S. aureus strains with reduced susceptibility to vancomycin, vancomycin-resistant S. aureus and multidrug-resistant Gram-negative bacteria (MDRGN), are emerging among the CHD population. Extended-spectrum β-lactamase Gram-negative bacteria (ESBLGN) are among the most common MDRGN strains. These ESBLGN are resistant to the great majority of antimicrobials. The carbapenems remain the only optimal antimicrobial choice to treat ESBLGN infections. Intrafacility spread of ARB in dialysis units occurs between patients through contaminated hands and clothes of healthcare workers (HCWs), as well as contaminated inanimate surfaces. Spread of ARB to family members of both patients and HCWs has also been documented.
  
  
  CONCLUSIONS
  Colonization and infection with ARB continues to present a significant threat to patients receiving CHD. Interventions to reduce the spread of ARB should include infection control measures and judicious use of antimicrobials.
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Graham M
authors.initials: GM
authors.lastname: Snyder
authors.forename: Erika M C
authors.initials: EM
authors.lastname: D'Agata
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus; D006090:Gram-Negative Bacteria; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D006435:Renal Dialysis / Q000009:adverse effects*; D020713:Vancomycin Resistance; D018440:beta-Lactam Resistance