Bacterial Resistance in Nephrology

Abstract

Bacterial resistance to antibiotics (ABR) is a major threat to public health, particularly in nephrology, with far-reaching consequences, including longer hospital stays, higher healthcare costs and increased mortality. Indeed, patients with chronic kidney disease (CKD) are a population at risk of developing infections caused by antibiotic-resistant bacteria (ARBs), given their overexposure to healthcare facilities and the quality of their gut microbiota already damaged by CKD. It is a population with very high rates of colonization and ARB infection worldwide. The mechanisms deployed by these AROs to counteract the effect of antibiotics are multiple. This may include the production of antibiotic-inhibiting enzyme (ATB), waterproofing of the bacterial membrane, or modification of the antibiotic target. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) species, and several multidrug-resistant Gram-negative organisms. The emergence and global spread of these ARBs is facilitated by ATB selection pressure, inter-agency transmission of resistance determinants, suboptimal infection control practices, and frequency of international travel, among other factors. The spread of this veritable pandemic highlights the urgent need for new treatment options, the implementation of awareness campaigns to properly prescribe antibiotics and improve infection prevention practices, particularly at hemodialysis centers.